No Prescription Medication is Effective for Viral Pharyngitis Symptoms
Viral pharyngitis requires only symptomatic treatment with over-the-counter analgesics—prescription antibiotics provide no benefit and should not be used. 1
Recommended Symptomatic Treatment
First-Line Analgesics (Over-the-Counter)
Acetaminophen or NSAIDs (ibuprofen) are the recommended treatments for moderate to severe symptoms or fever control in viral pharyngitis. 1, 2
- Ibuprofen: 400 mg every 4-6 hours as needed for pain relief 3
- Acetaminophen: 650 mg per dose as needed 4
- Aspirin must be avoided in children due to risk of Reye syndrome 1, 2
Adjunctive Symptomatic Measures
- Topical anesthetics (lozenges containing ambroxol, lidocaine, or benzocaine) may provide temporary relief 1
- Warm salt water gargles can provide symptom relief for patients old enough to gargle 1
Why No Prescription Medications?
Antibiotics Are Contraindicated
The Infectious Diseases Society of America and CDC explicitly recommend against prescribing antibiotics for viral pharyngitis—they provide no benefit and contribute to antibiotic resistance. 1
- Viral pharyngitis is self-limited, typically resolving in less than 1 week 1
- Clinical features suggesting viral etiology include cough, rhinorrhea (runny nose), hoarseness, and oral ulcers 1
Corticosteroids Are Not Recommended
Corticosteroids are not recommended for routine use in viral pharyngitis despite minimal symptom reduction (approximately 5 hours), as potential adverse effects outweigh modest benefits. 1, 2
Critical Diagnostic Distinction
Testing for Group A Streptococcus is not necessary when clinical features strongly suggest viral etiology (presence of cough, rhinorrhea, hoarseness, or oral ulcers). 1
However, if features suggest possible streptococcal infection—sudden onset, fever, cervical lymphadenopathy without cough or nasal symptoms—then rapid antigen detection testing or throat culture should be performed. 1
Common Pitfalls to Avoid
- Do not prescribe antibiotics for viral pharyngitis—this is the most common error, with 70% of patients with sore throats receiving unnecessary antimicrobial prescriptions nationally 5
- Do not use aspirin in children with viral infections due to Reye syndrome risk 1, 2
- Do not routinely use corticosteroids for symptom relief 1, 2
Bottom Line
For viral pharyngitis, no prescription medication is indicated or effective. Management consists entirely of over-the-counter analgesics (acetaminophen or ibuprofen) and supportive measures. The key clinical skill is distinguishing viral pharyngitis from bacterial (streptococcal) pharyngitis to avoid unnecessary antibiotic use while ensuring appropriate treatment when Group A Streptococcus is confirmed. 1, 6