From the Guidelines
Treatment for viral pharyngitis in pediatric patients is primarily supportive, as antibiotics are ineffective against viral infections. The mainstay of treatment includes adequate hydration with water or electrolyte solutions, rest, and appropriate pain management with acetaminophen (10-15 mg/kg every 4-6 hours, maximum 5 doses per day) or ibuprofen (5-10 mg/kg every 6-8 hours with food) 1. Honey (5-10 mL) can be given to children over 1 year of age to soothe throat irritation. Warm salt water gargles (1/4 to 1/2 teaspoon of salt in 8 ounces of warm water) may provide relief for children old enough to gargle. Cold liquids, popsicles, or ice chips can help numb the throat and maintain hydration. Humidification of room air may also ease symptoms. Some key points to consider in the treatment of viral pharyngitis include:
- Monitoring for signs of dehydration, including decreased urination, dry mouth, and lethargy
- Medical reevaluation if symptoms persist beyond 10 days, worsen after initial improvement, or if the child develops high fever, difficulty breathing, or inability to swallow
- Avoiding the use of antibiotics, as they are ineffective against viral infections and can contribute to antimicrobial resistance 1
- Considering the use of analgesic or antipyretic agents, such as acetaminophen or nonsteroidal anti-inflammatory drugs, to treat moderate to severe symptoms or control high fever 1
- Avoiding the use of aspirin in children, as it is not recommended due to the risk of Reye's syndrome 1. Most viral pharyngitis cases resolve within 7-10 days without specific antiviral therapy. Viral pharyngitis is self-limiting because the immune system naturally clears the infection, making supportive care the appropriate approach while the body fights the virus.
From the Research
Treatment for Viral Pharyngitis in Pediatrics
- Most cases of acute pharyngitis in children are caused by viruses and are benign and self-limited 2
- The use of nonsteroidal anti-inflammatory agents (NSAIAs) is advised for the treatment of pain in children with viral pharyngitis 3
- NSAIAs have been shown to relieve pharyngitis pain better than acetaminophen 3
Diagnosis and Treatment Strategies
- Strategies for diagnosis and treatment of acute pharyngitis are directed at distinguishing children with viral pharyngitis from children with group A beta-hemolytic streptococcal pharyngitis 2
- Making this distinction is crucial in attempting to minimize the unnecessary use of antimicrobial agents in children 2
- Antibiotics are commonly recommended for proven group A streptococcus (GAS) pharyngitis as they may prevent rare but severe complications, such as rheumatic fever (RF) 4
Antibiotic Treatment
- Penicillin or amoxicillin are the antibiotics of choice for GAS pharyngitis as they are narrow spectrum and resistance resulting in clinical failure is yet to be documented 4
- A 10-day oral course is recommended as shorter courses appear to be less likely to clear carriage of GAS 4
- However, the evidence that one needs to clear carriage to prevent RF is low quality and indirect 4
Management of Acute Pharyngitis
- Accurate diagnosis is imperative due to increasing antimicrobial resistance because of antimicrobial overuse 5
- Appropriate management of acute pharyngitis depends on proper use and interpretation of clinical findings, rapid antigen-detection tests, and throat cultures 5
- There is much room for improvement in the management of acute pharyngitis in children and adolescents, with a substantial number of physicians using inappropriate strategies, particularly for children with likely viral pharyngitis 5