What is the appropriate pain management for viral pharyngitis?

Pain Management for Viral Pharyngitis

For viral pharyngitis, use acetaminophen or NSAIDs (such as ibuprofen) as first-line analgesic therapy for moderate to severe throat pain or fever control. 1

Diagnostic Confirmation

Before treating pain, confirm the viral etiology by recognizing key clinical features:

• Do not test for Group A Streptococcus when patients present with cough, rhinorrhea (runny nose), hoarseness, or oral ulcers—these strongly suggest viral pharyngitis 1, 2
• Patients with these viral features should receive symptomatic treatment only, without antibiotics 3, 1

First-Line Analgesic Options

Acetaminophen or NSAIDs are the recommended analgesics for pain and fever relief:

• Both provide effective symptomatic relief for moderate to severe throat pain 1, 4
• NSAIDs like ibuprofen offer additional anti-inflammatory benefits 1
• Aspirin must be avoided in children due to the risk of Reye syndrome when used during viral infections 1, 4

Adjunctive Symptomatic Measures

Additional options that may provide temporary relief include:

• Topical anesthetic lozenges containing ambroxol, lidocaine, or benzocaine can provide short-term pain relief 1
• Warm salt water gargles are appropriate for patients old enough to gargle safely 1, 4

What NOT to Do: Critical Pitfalls

Avoid corticosteroids for routine viral pharyngitis management:

• Corticosteroids provide only minimal symptom reduction (approximately 5 hours of benefit) 1
• The potential adverse effects outweigh this minimal benefit 1
• They are not recommended for routine use 1

Never prescribe antibiotics for viral pharyngitis:

• Antibiotics provide no benefit for viral infections 3, 1
• Inappropriate antibiotic use contributes to antimicrobial resistance 1, 2
• The American College of Physicians and CDC explicitly recommend against antibiotics when viral features are present 3, 1

Clinical Reasoning

The evidence consistently supports a conservative, symptomatic approach to viral pharyngitis pain management. The 2016 American College of Physicians/CDC guidelines 3 and the comprehensive 2026 guideline summaries 1, 2 all converge on the same recommendation: simple analgesics are sufficient and appropriate. The key is distinguishing viral from bacterial pharyngitis upfront—once viral etiology is established through clinical features (cough, rhinorrhea, hoarseness, oral ulcers), the management pathway is straightforward symptomatic care without antibiotics or aggressive interventions like corticosteroids.