Management of Acute Viral Laryngitis
Acute viral laryngitis should be managed with symptomatic treatment only—antibiotics are not indicated and provide no objective benefit. 1, 2
Core Treatment Approach
Symptomatic relief is the cornerstone of management and should include 1:
- Analgesics or antipyretics (acetaminophen, NSAIDs) for pain or fever 1
- Adequate hydration to maintain mucosal moisture 1
- Voice rest to reduce vocal fold irritation 1
- Voice conservation techniques should be explained to patients 1
What NOT to Do
Antibiotics Are Ineffective
Do not prescribe antibiotics for viral laryngitis. The evidence is clear 1, 3, 2:
- A Cochrane systematic review of 351 patients found no significant differences in objective voice scores between antibiotic and placebo groups 2
- Penicillin V showed no benefit in resolution of vocal symptoms, rhinorrhea, or cough in 100 adults with acute laryngitis 3
- While erythromycin showed modest subjective improvements at one week, these benefits do not outweigh the costs, adverse effects, or contribution to antibiotic resistance 2
Corticosteroids Should Be Avoided
Do not routinely use systemic corticosteroids for viral laryngitis in adults due to 1:
- Lack of supporting evidence for efficacy
- Potential for significant adverse effects
- No demonstrated improvement in morbidity or quality of life
When to Reconsider or Escalate
Additional evaluation is warranted if 1:
- Symptoms persist beyond 2-3 weeks
- Progressive worsening of symptoms occurs
- Signs of airway compromise develop
- Suspicion of bacterial superinfection arises
Exceptions Where Antibiotics May Be Appropriate
Antibiotics should only be considered in specific high-risk scenarios 1:
- Immunocompromised patients
- Confirmed bacterial infection (not presumed)
- Bacterial laryngotracheitis with mucosal crusting and increased work of breathing
Patient Education Points
Counsel patients that 1:
- Laryngitis is viral in nature and self-limited
- Symptoms typically resolve within 1-2 weeks
- Colored mucus does NOT indicate bacterial infection 1
- Antibiotics will not speed recovery and may cause harm 3, 2
Common Pitfalls to Avoid
Do not be misled by purulent-appearing secretions—this does not differentiate viral from bacterial laryngitis 1. The misuse of antibiotics contributes to bacterial resistance, unnecessary healthcare costs, potential side effects, and risk of laryngeal candidiasis 1.
True bacterial infections present with high fever (≥39°C) for at least 3 consecutive days plus thick colored mucus—this is the threshold for considering bacterial etiology 1.