Treatment for Viral Laryngitis
Primary Recommendation
Viral laryngitis should be managed with symptomatic treatment only—voice rest, hydration, and analgesics for pain or fever—while avoiding antibiotics and systemic corticosteroids, which provide no benefit and cause potential harm. 1, 2
Core Treatment Approach
Symptomatic Management (First-Line)
- Voice rest is essential to reduce vocal fold irritation and promote healing 2
- Adequate hydration maintains mucosal moisture and reduces irritation 1, 2
- Analgesics or antipyretics (acetaminophen or NSAIDs) for pain or fever relief 1, 2
- Avoid both loud speaking and whispering, as both strain the vocal cords 2
The condition is self-limited, with improvement typically occurring within 7-10 days even without specific treatment 2. Common viral causes include parainfluenza viruses, rhinovirus, influenza, and adenovirus 1, 2.
What NOT to Prescribe
Antibiotics—Strongly Contraindicated
- Antibiotics have no objective benefit in treating viral laryngitis and should not be routinely prescribed 1, 2
- A double-blind study demonstrated that penicillin V showed no difference from placebo in resolution of vocal symptoms 3
- Antibiotic misuse contributes to bacterial resistance, unnecessary healthcare costs, potential side effects, and risk of laryngeal candidiasis 1, 2
Systemic Corticosteroids—Not Recommended
- Routine use of systemic corticosteroids is not supported by evidence and carries significant risks 1, 2
- Potential adverse effects include cardiovascular disease, hypertension, osteoporosis, cataracts, impaired wound healing, infection risk, and mood disorders 2
When to Reconsider or Escalate
Red Flags Requiring Additional Evaluation
- Symptoms persisting beyond 2-3 weeks 1, 2
- Progressive worsening of symptoms 1, 2
- Signs of airway compromise 1, 2
- Suspicion of bacterial superinfection 1, 2
Exceptions Where Antibiotics May Be Appropriate
- Immunocompromised patients 1
- Confirmed bacterial infection (not just colored mucus, which does NOT differentiate viral from bacterial) 1
- Bacterial laryngotracheitis with mucosal crusting and increased work of breathing 1
- True bacterial infections presenting with high fever (≥39°C/102.2°F) for at least 3 consecutive days plus thick colored mucus 1
If bacterial infection is suspected, culture by biopsy may be needed, as infectious laryngitis can involve MSSA, MRSA, Pseudomonas aeruginosa, or Serratia marcescens, often requiring prolonged antibiotic courses 4.
Patient Education Points
- Explain the viral nature of the condition and expected time course 1, 2
- Recommend voice conservation techniques and adequate hydration 1, 2
- Advise against requesting antibiotics or steroids for typical viral laryngitis 2
- Reassure that colored mucus does NOT indicate bacterial infection requiring antibiotics 1