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Viral Pharyngitis Follow-up

  • Author: KoKo Aung, MD, MPH, FACP; Chief Editor: Michael Stuart Bronze, MD  more...
Updated: Oct 22, 2015


Washing hands frequently, using disposable tissues, and limiting human contact are important preventive measures for the common cold syndrome and other viral pharyngitis. No consistent benefit was demonstrated in preventing a common cold with large doses of vitamin C.

Live adenovirus vaccines have been successfully used in military populations but are not available for civilian use.

Administration of influenza vaccine to high-risk individuals and those who want to prevent influenza is the major preventive measure. Amantadine may be used to prevent influenza A during outbreaks.



The complication rate of viral pharyngitis associated with a common cold is quite low. Purulent bacterial otitis media and sinusitis may occur.

Infectious mononucleosis may be complicated by tonsillar and peritonsillar abscess, necrotic epiglottitis, airway obstruction, hepatic dysfunction, splenic rupture, hypersplenism, encephalitis, pneumonitis, pericarditis, and hematologic disorders.

Herpetic pharyngitis may lead to necrotizing tonsillitis, epiglottitis, and recurrent disease.

Influenza may be complicated by secondary bacterial pneumonia. Pneumococcal pneumonia is most common. Staphylococcal pneumonia is most serious.

RSV infection, particularly in infants, elderly persons, and patients with underlying COPD, may be complicated by pneumonia and respiratory failure.

Complications of HIV infection are beyond the scope of this article. For more information, see the article HIV Disease.



The prognosis of a patient with a common cold is excellent. Most adults recover in less than a week, and most children in less than 2 weeks.

In patients with infectious mononucleosis, fever disappears in approximately 10 days. Lymphadenopathy and splenomegaly disappear in approximately 4 weeks. Debility sometimes remains for approximately 2-3 months, and the condition is occasionally fatal because of splenic rupture, hypersplenism, or encephalitis.

The duration of uncomplicated influenza is 1-7 days. Prognosis is excellent. Most fatalities are due to secondary bacterial pneumonia.

Enteroviral pharyngitis is usually benign and self-limited.


Patient Education

Patient education should emphasize the natural course of viral infection and that it takes several days to feel better. Patients must understand that antibiotics are not needed for sore throats of viral origin. Risk of allergic reactions, fungal superinfection, and bacterial resistance should be discussed.

Patients should be reassured that certain measures, including pain relievers, throat sprays or lozenges, and gargling with warm salt water, improve symptoms without antibiotics. It is often challenging to reassure that antibiotic therapy is unnecessary.[2]

Fever persisting for more than 5 days, extreme throat pain causing dysphagia, inability to open the mouth wide, or fainting spells when standing should prompt a visit to a doctor.

For excellent patient education resources, visit eMedicineHealth's Cold and Flu Center, Infections Center, and Ear, Nose, and Throat Center. Also, see eMedicineHealth's patient education articles Colds, Sore Throat, Mononucleosis, and Tonsillitis.

Contributor Information and Disclosures

KoKo Aung, MD, MPH, FACP Chief, Division of General Internal Medicine, O Roger Hollan Professor of Internal Medicine, Director, Office of Educational Programs, Department of Medicine, University of Texas Health Science Center at San Antonio

KoKo Aung, MD, MPH, FACP is a member of the following medical societies: American College of Physicians, Society of General Internal Medicine

Disclosure: Nothing to disclose.


Ambrish Ojha, MBBS 

Ambrish Ojha, MBBS is a member of the following medical societies: American College of Physicians, American Medical Association

Disclosure: Nothing to disclose.

Carson Lo, MD Consultant, West Houston Infectious Disease Associates

Carson Lo, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Texas Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Gordon L Woods, MD Consulting Staff, Department of Internal Medicine, University Medical Center

Gordon L Woods, MD is a member of the following medical societies: Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, Oklahoma State Medical Association, Southern Society for Clinical Investigation, Association of Professors of Medicine, American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

Gregory William Rutecki, MD Professor of Medicine, Fellow of The Center for Bioethics and Human Dignity, University of South Alabama College of Medicine

Gregory William Rutecki, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society of Nephrology, National Kidney Foundation, Society of General Internal Medicine

Disclosure: Nothing to disclose.

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