From the Guidelines
Treatment for viral pharyngitis primarily focuses on symptom management since antibiotics are ineffective against viral infections. The goal of treatment is to reduce morbidity, mortality, and improve quality of life by alleviating symptoms and supporting the body's natural immune response. Rest and adequate hydration are essential components of recovery. Over-the-counter pain relievers such as acetaminophen (Tylenol) 650mg every 6 hours or ibuprofen (Advil, Motrin) 400mg every 6-8 hours can help reduce throat pain and fever, as recommended by the American College of Physicians and the Centers for Disease Control and Prevention 1. Throat lozenges containing benzocaine or menthol may provide temporary relief of sore throat. Gargling with warm salt water (1/4 to 1/2 teaspoon of salt in 8 ounces of warm water) several times daily can soothe throat irritation. Humidifiers can add moisture to the air and ease throat discomfort.
Some key points to consider in the management of viral pharyngitis include:
- The use of cough suppressants, expectorants, first-generation antihistamines, decongestants, and β-agonists may provide symptomatic relief, although data to support specific therapies are limited 1.
- β-Agonists have not been shown to benefit patients without asthma or chronic obstructive lung disease 1.
- Symptomatic therapy has not been shown to shorten the duration of illness 1.
- Over-the-counter symptomatic relief has a low incidence of minor adverse effects, including nausea, vomiting, headache, and drowsiness 1.
Most cases of viral pharyngitis resolve within 7-10 days without specific antiviral treatment. If symptoms persist beyond 10 days, worsen significantly, or if you develop difficulty breathing or swallowing, seek medical attention as this could indicate a bacterial infection or complications, as suggested by the Infectious Diseases Society of America 1. Viral pharyngitis is self-limiting because the body's immune system naturally fights off the infection, making supportive care the cornerstone of treatment.
In terms of specific treatment regimens, the 2012 IDSA clinical guidelines recommend antibiotic therapy only for patients with a positive streptococcal test result 1. For patients diagnosed with group A streptococcal infection, antibiotics shorten the duration of sore throat by 1 to 2 days, but the benefit is modest and the number needed to treat to reduce symptoms is 6 after 3 days of treatment and 21 after 1 week of treatment 1. However, for viral pharyngitis, antibiotics are not recommended, and treatment should focus on symptom management and supportive care.
From the Research
Treatment for Viral Pharyngitis
- The use of aspirin or nonsteroidal anti-inflammatory agents (NSAIAs) is advised in adults and NSAIAs in children for the treatment of pain in viral pharyngitis 2.
- Studies have shown that NSAIAs relieve pharyngitis pain better than acetaminophen 2.
- For symptomatic treatment, ibuprofen and naproxen are recommended 3.
- Steroids are effective in relieving pain in acute pharyngitis, but the benefits have to be balanced with possible adverse drug effects 4.
Antibiotic Treatment
- Penicillin remains the antibiotic of choice for group A beta-hemolytic streptococcal (GAS) pharyngitis, with no reported resistance 2, 5.
- Amoxicillin is equally effective and more palatable than penicillin 5.
- Erythromycin and first-generation cephalosporins are options in patients with penicillin allergy 5.
- Antibiotic treatment is unnecessary in many cases of acute sore throat, and a risk-adapted approach using clinical scores is recommended 3.
Diagnosis and Management
- Rapid antigen detection tests and throat cultures can be used with clinical findings to identify the inciting organism 5, 6.
- A thorough history is key to diagnosing pharyngitis, and physicians should exercise restraint in antibiotic initiation for pharyngitis 6.
- Scores can be used to assess the risk of bacterial pharyngitis, and delayed prescribing is recommended for moderate risk 3.