Acute Viral Pharyngitis
This is almost certainly acute viral pharyngitis, given the 3-day sore throat accompanied by upper respiratory symptoms (cold) and fever—antibiotics are not indicated and testing for strep throat is unnecessary. 1, 2
Clinical Reasoning
The presence of "cold" symptoms (implying rhinorrhea/nasal congestion) alongside sore throat strongly indicates a viral etiology rather than bacterial pharyngitis. 1, 2 Patients presenting with cough, rhinorrhea, hoarseness, or conjunctivitis are unlikely to have bacterial pharyngitis, and routine testing for Group A Streptococcus is not recommended because these features strongly indicate a viral cause. 1
Why This Is Not Strep Throat
Group A streptococcal pharyngitis typically presents with:
- Absence of cough (a key distinguishing feature) 3, 2
- Tonsillar exudate or swelling 3
- Tender anterior cervical lymphadenopathy 3, 2
- High fever (often >39°C) 3
The presence of upper respiratory "cold" symptoms makes strep throat highly unlikely. 1, 2 The Modified Centor Criteria would likely yield a score of 0-2 points (indicating viral pharyngitis), which does not warrant testing or antibiotics. 2
Expected Clinical Course
Viral pharyngitis is self-limited and symptoms typically resolve within 7-10 days, with improvement expected after 3-4 days. 2 Even without treatment, fever and constitutional symptoms disappear spontaneously within 3-4 days. 3
Management Approach
Symptomatic Treatment Only
- First-line analgesia: Ibuprofen or acetaminophen for sore throat pain and fever 1
- Adjunctive options: Throat lozenges, salt water gargles, topical anesthetics 2
- Combination products: Antihistamine/analgesic/decongestant combinations may provide clinically meaningful improvement in approximately 25% of patients 1
What NOT to Do
Do not prescribe antibiotics. 1, 2 For acute sore throat with viral characteristics (gradual onset, low-grade fever, absence of tender anterior cervical nodes or tonsillar exudates), antibiotics provide no clinical benefit and increase the risk of adverse drug reactions and antibiotic resistance. 1, 2 More than 60% of adults presenting with sore throat inappropriately receive antibiotics. 4
Red Flags Requiring Re-evaluation
Reassess the patient if: 1
- Symptoms persist beyond 10 days
- Symptoms markedly worsen rather than improve
- High fever develops (>39°C)
- Signs of systemic toxicity appear
- New tender anterior cervical lymphadenopathy or tonsillar exudates emerge (suggesting possible bacterial superinfection) 1
Common Pitfall to Avoid
The most common error is prescribing antibiotics for viral pharyngitis "just in case" or due to patient pressure. 3, 2 This practice increases antibiotic resistance, exposes patients to unnecessary adverse effects (including diarrhea, rash, and C. difficile colitis), and provides zero clinical benefit when bacterial infection is not present. 3