What is the recommended treatment for a 25-year-old female patient with a sore throat due to a viral upper respiratory tract infection and no chronic medical conditions?

Treatment of Viral Sore Throat in a Young Adult

For a 25-year-old woman with viral pharyngitis, supportive care with adequate rest, hydration, and analgesics is the recommended treatment—antibiotics are not indicated and cause more harm than benefit. 1

Symptomatic Management

Analgesics for pain control:

• Offer ibuprofen or acetaminophen immediately for throat pain and fever relief 2, 3
• These medications provide the primary symptomatic benefit for viral pharyngitis 2

Non-pharmacological comfort measures:

• Ensure adequate rest and hydration to support immune function 2
• Use steamy showers to humidify the airway and soothe irritated mucosa 2
• Sleep with the head of the bed elevated to reduce postnasal drip and throat irritation 2
• Apply warm facial packs for local comfort 2

Salt Water Gargling: Evidence-Based Recommendation

Simple water gargling is effective and should be recommended:

• Water gargling reduces URTI incidence by 36% (incidence rate ratio 0.64,95% CI 0.41-0.99) compared to no gargling 4
• Gargling at least three times daily is the studied regimen 4
• This is a virtually cost-free intervention with proven efficacy 4
• Hypertonic saline nasal irrigation and gargling reduces illness duration by 1.9 days (p=0.01) and viral shedding by ≥0.5 log10/day (p=0.04) 5

Important caveat: Povidone-iodine gargling showed no significant benefit over usual care (incidence rate ratio 0.89,95% CI 0.60-1.33), so plain water is preferred 4

Expected Timeline and Follow-Up

Natural course:

• Viral pharyngitis symptoms typically last up to 2 weeks, with approximately 90% of patients symptom-free by one week even without treatment 2
• This self-limited course means no specific antiviral treatment is needed 2

When to follow up:

• Return if symptoms worsen, especially with headache or high fever 2
• Return if symptoms have not improved within 3 to 5 days 2
• Symptoms persisting beyond 2 weeks are atypical and warrant evaluation for non-infectious causes 2

Antibiotic Stewardship: Critical Pitfall to Avoid

Do not prescribe antibiotics without confirmed bacterial infection:

• Antibiotics should only be prescribed if Group A Streptococcus is confirmed by rapid antigen detection test or throat culture 1
• Viral pharyngitis is self-limited and resolves spontaneously without antibiotics 2
• Over 60% of adults with sore throat inappropriately receive antibiotics 6
• The number needed to harm from antibiotic adverse effects exceeds the number needed to treat for most respiratory infections 1

Environmental Measures

Preventive strategies:

• Avoid cigarette smoke, pollution, and relevant allergens that can prolong symptoms 2
• Practice appropriate handwashing, as direct hand contact is the primary route of viral spread 2