What is the recommended treatment for a patient with viral pharyngitis?

Treatment for Viral Pharyngitis

Viral pharyngitis requires only symptomatic treatment with analgesics/antipyretics—antibiotics should never be prescribed, and testing for Group A Streptococcus is not necessary when clinical features clearly indicate viral etiology. 1

Confirming Viral Etiology

Before treating as viral pharyngitis, ensure the patient has clinical features that strongly suggest viral rather than bacterial infection:

• Presence of viral features (cough, rhinorrhea, hoarseness, oral ulcers) indicates no testing for GAS is needed 2, 1
• Absence of bacterial features (no sudden onset fever, no tonsillar exudates, no tender anterior cervical lymphadenopathy without respiratory symptoms) 1
• Testing for streptococcal infection should only be considered if features suggest possible bacterial infection (sudden onset, fever, cervical lymphadenopathy without cough or nasal symptoms) 1

Symptomatic Treatment Approach

First-Line Analgesic/Antipyretic Therapy

Acetaminophen or NSAIDs are the cornerstone of treatment for moderate to severe symptoms or fever control: 1

• NSAIDs (ibuprofen) are more effective than acetaminophen for fever and pain control and should be the preferred analgesic 3
• Acetaminophen is also effective and appropriate, particularly in breastfeeding mothers 3
• Aspirin must be avoided in children due to risk of Reye syndrome 2, 1, 3

Adjunctive Symptomatic Measures

Additional relief can be provided through:

• Topical anesthetics containing ambroxol, lidocaine, or benzocaine may provide temporary symptomatic relief 1, 3
• Warm salt water gargles can provide symptom relief for patients old enough to gargle 1, 3

What NOT to Do

Critical Pitfalls to Avoid

Do not prescribe antibiotics for viral pharyngitis—this provides no benefit and contributes to antibiotic resistance 1

Do not use corticosteroids routinely—they provide only minimal reduction in symptom duration (approximately 5 hours) and have potential adverse effects including immunosuppression, glucose dysregulation, and mood changes that outweigh the marginal symptomatic benefit 1, 3

Do not use aspirin in children with viral infections due to risk of Reye syndrome 1, 3

Expected Clinical Course

• Viral pharyngitis is self-limited and typically resolves in less than 1 week 1
• Symptoms should improve with symptomatic treatment alone 1, 4
• If fever persists beyond 48-72 hours or symptoms worsen, reconsider the diagnosis and evaluate for bacterial superinfection or complications 1