Viral Pharyngitis Treatment & Management
- Author: KoKo Aung, MD, MPH, FACP; Chief Editor: Michael Stuart Bronze, MD more...
Treatment strategies for patients with acute pharyngitis are based on epidemiologic factors, signs and symptoms, and results of laboratory tests. Rest, oral fluids, and salt-water gargling (for soothing effect) are the main supportive measures in patients with viral pharyngitis.
Analgesics and antipyretics may be used for relief of pain or pyrexia. Acetaminophen is the drug of choice. Traditionally, aspirin has been used, but it may increase viral shedding. Aspirin should not be used in children or adolescents, especially with influenza, because of its association with Reye syndrome. One study proved that ibuprofen was superior to acetaminophen for symptomatic relief in children aged 6-12 years. A double-blind randomized study involving adult patients from 27 study centers in Latin America found that 5 days of treatment with celecoxib 200 mg once daily is as effective as diclofenac 75 mg twice daily in the symptomatic treatment of viral pharyngitis.
Anesthetic gargles and lozenges, such as benzocaine, may be used for symptomatic relief. Hospitalization for intravenous hydration may be necessary when odynophagia is intense.
Antibiotics do not hasten recovery or reduce the frequency of bacterial complications. The risks of prescribing antibiotics in patients with viral pharyngitis include the common side effects of antibiotics (diarrhea, rashes, candidiasis, unplanned pregnancy secondary to oral-contraceptive failure) and the rare occurrence of anaphylaxis.
Specific treatment of viral infections is available for only a few viruses.
Amantadine and rimantadine are FDA approved for treatment of influenza A virus infections among adults and children aged 1 year or older. However, because of resistance in circulating influenza A virus strains, they are no longer recommended for antiviral treatment of influenza A. Adamantanes, particularly amantadine, can be associated with a significant discontinuation rate due to CNS side effects such as lightheadedness, difficulty concentrating, nervousness, and insomnia in older adults.
The Advisory Committee on Immunization Practices (ACIP) recommends antiviral treatment with a neuraminidase inhibitor (oseltamivir or zanamivir) for outpatients with suspected or confirmed influenza who are at higher risk for influenza complications because of age or underlying medical conditions. Persons at higher risk for influenza complications recommended for antiviral treatment include the following:
Children aged 2 years or younger
Adults aged 65 years or older
Persons with chronic pulmonary (including asthma), cardiovascular (except hypertension alone), renal, hepatic, hematological (including sickle cell disease), metabolic (including diabetes mellitus), or neurologic and neurodevelopment conditions (including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy, stroke, intellectual disability [mental retardation], moderate to severe developmental delay, muscular dystrophy, or spinal cord injury)
Persons with immunosuppression, including that caused by medications or by HIV infection
Women who are pregnant or postpartum (within 2 weeks after delivery)
Persons younger than 19 years who are receiving long-term aspirin therapy
American Indians/Alaska Natives
Persons who are morbidly obese (ie, body mass index ≥40)
Residents of nursing homes and other chronic-care facilities
The greatest benefit is when antiviral treatment is started within 48 hours of influenza illness onset. Antiviral treatment also can be considered for any previously healthy, symptomatic outpatient not at high risk with confirmed or suspected influenza on the basis of clinical judgment, if treatment can be initiated within 48 hours of illness onset.
A 2014 systematic review published in the Cochrane Library found that neuraminidase inhibitors have small nonspecific effects on reducing the time to alleviation of influenza symptoms in healthy adults, but not in asthmatic children. Treatment trials with oseltamivir or zanamivir do not settle the question of whether the complications of influenza (eg, pneumonia) are reduced because of a lack of diagnostic definitions. The use of oseltamivir increases the risk of adverse effects such as nausea, vomiting, psychiatric effects, and renal events in adults and vomiting in children. The Cochrane authors concluded that the balance between benefits and harms should be considered when making decisions about neuraminidase inhibitors for treatment of influenza and that the influenza virus–specific mechanism of action proposed by the producers does not fit the clinical evidence.
EBV infectious mononucleosis
Specific antiviral therapy with acyclovir, ganciclovir, and interferon alfa reduces viral shedding but does not improve clinical outcome.
Corticosteroids may improve the symptoms, but they are generally not recommended because infectious mononucleosis is usually benign and self-limited.
However, corticosteroids are indicated if the patient has massive tonsillar hypertrophy that threatens to obstruct the airway.
Herpes simplex virus
In an immunocompetent host, oral acyclovir, famciclovir, and valacyclovir decrease the duration of symptoms and viral shedding.
In an immunocompromised host, these drugs decrease pain and viral shedding and accelerate healing of lesions. These drugs are helpful in severely afflicted patients.
Acute retroviral syndrome
Several unique considerations favor antiretroviral therapy during this phase of HIV infection. Treatment may limit the extent of viral dissemination throughout the body, attenuate the progress of HIV infection by lowering the plasma viral RNA set point, and limit the extent of viral genetic variability, which is responsible for drug resistance.
Treatment may also allow salvage of a CD4 T-cell–specific immune response that may be important in the immune control of HIV infection.
Drinking large amounts of fluid is recommended. No specific dietary restrictions are needed. Soft, cold foods (eg, ice cream, popsicles) are more easily tolerated.
No restriction in activity is required.
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