Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Viral Pharyngitis Treatment & Management

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

Medical Care

Treatment strategies for patients with acute pharyngitis are based on epidemiologic factors, signs and symptoms, and results of laboratory tests.[1] Rest, oral fluids, and salt-water gargling (for soothing effect) are the main supportive measures in patients with viral pharyngitis.[2]

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.[3]

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.[4]

Specific treatment of viral infections is available for only a few viruses.

Influenza

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.[5] 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.[6]

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:[5]

  • 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.[7] 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.

Updated information about influenza activity and antiviral resistance can be found on the Web sites of the US Centers for Disease Control and Prevention[8] and the World Health Organization.[9]

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.

Next

Diet

Drinking large amounts of fluid is recommended. No specific dietary restrictions are needed. Soft, cold foods (eg, ice cream, popsicles) are more easily tolerated.

Previous
Next

Activity

No restriction in activity is required.

Previous
 
 
Contributor Information and Disclosures
Author

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.

Coauthor(s)

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.

References
  1. Perkins A. An approach to diagnosing the acute sore throat. Am Fam Physician. 1997 Jan. 55(1):131-8, 141-2. [Medline].

  2. Bisno AL. Acute pharyngitis. N Engl J Med. 2001 Jan 18. 344(3):205-11. [Medline].

  3. Weckx LL, Ruiz JE, Duperly J, et al. Efficacy of celecoxib in treating symptoms of viral pharyngitis: a double-blind, randomized study of celecoxib versus diclofenac. J Int Med Res. 2002 Mar-Apr. 30(2):185-94. [Medline].

  4. Graham A, Fahey T. Evidence based case report. Sore throat: diagnostic and therapeutic dilemmas. BMJ. 1999 Jul 17. 319(7203):173-4. [Medline].

  5. Fiore AE, Fry A, Shay D, Gubareva L, Bresee JS, Uyeki TM. Antiviral agents for the treatment and chemoprophylaxis of influenza --- recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2011 Jan 21. 60(1):1-24. [Medline].

  6. Keyser LA, Karl M, Nafziger AN, Bertino JS Jr. Comparison of central nervous system adverse effects of amantadine and rimantadine used as sequential prophylaxis of influenza A in elderly nursing home patients. Arch Intern Med. 2000 May 22. 160(10):1485-8. [Medline].

  7. Jefferson T, Jones MA, Doshi P, Del Mar CB, Hama R, Thompson MJ, et al. Neuraminidase inhibitors for preventing and treating influenza in healthy adults and children. Cochrane Database Syst Rev. 2014 Apr 10. 4:CD008965. [Medline].

  8. CDC. Seansonal Flu Weekly Report. Available at http://www.cdc.gov/flu/weekly/index.htm. Accessed: July 29, 2011.

  9. WHO. Infleunza Update. Available at http://www.who.int/csr/disease/influenza/latest_update_GIP_surveillance/en/. Accessed: July 29, 2011.

  10. Cingi C, Songu M, Ural A, Yildirim M, Erdogmus N, Bal C. Effects of chlorhexidine/benzydamine mouth spray on pain and quality of life in acute viral pharyngitis: a prospective, randomized, double-blind, placebo-controlled, multicenter study. Ear Nose Throat J. 2010 Nov. 89(11):546-9. [Medline].

  11. Ebell MH, Smith MA, Barry HC, et al. The rational clinical examination. Does this patient have strep throat?. JAMA. 2000 Dec 13. 284(22):2912-8. [Medline].

  12. Little P, Gould C, Williamson I, Warner G, Gantley M, Kinmonth AL. Reattendance and complications in a randomised trial of prescribing strategies for sore throat: the medicalising effect of prescribing antibiotics. BMJ. 1997 Aug 9. 315(7104):350-2. [Medline].

  13. McIsaac WJ, White D, Tannenbaum D, et al. A clinical score to reduce unnecessary antibiotic use in patients with sore throat. CMAJ. 1998 Jan 13. 158(1):75-83. [Medline].

  14. Singh S, Dolan JG, Centor RM. Optimal management of adults with pharyngitis--a multi-criteria decision analysis. BMC Med Inform Decis Mak. 2006 Mar 13. 6:14. [Medline].

  15. Cunha BA. Group A streptococcal pharyngitis. Emerg Med. 1990. 22:93-96.

  16. Cunha BA. Group A streptococcal pharyngitis versus colonization. Intern Med. 1994. 15:18-19.

  17. Cunha BA. The Sore Throat: Mycoplasma pneumoniae pharyngitis. Emerg Med. 1988. 20:245-252.

  18. Gwaltney JM Jr, Bisno AL. Pharyngitis. Mandell GI, Bennett JE, Dolin R, eds. Mandell, Douglas & Bennett's Principles of Infectious Diseases. Churchill Livingstone; 2000. Vol 1: 656-62.

  19. Huovinen P, Lahtonen R, Ziegler T, et al. Pharyngitis in adults: the presence and coexistence of viruses and bacterial organisms. Ann Intern Med. 1989 Apr 15. 110(8):612-6. [Medline].

  20. McIsaac WJ, Goel V, Slaughter PM. Reconsidering sore throats. Part 2: Alternative approach and practical office tool. Can Fam Physician. 1997 Mar. 43:495-500. [Medline].

  21. McIsaac WJ, Goel V, Slaughter PM, et al. Reconsidering sore throats. Part I: Problems with current clinical practice. Can Fam Physician. 1997 Mar. 43:485-93. [Medline].

  22. Paradise JL. Etiology and management of pharyngitis and pharyngotonsillitis in children: a current review. Ann Otol Rhinol Laryngol Suppl. 1992 Jan. 155:51-7. [Medline].

  23. Pichichero ME. Sore throat after sore throat after sore throat. Are you asking the critical questions?. Postgrad Med. 1997 Jan. 101(1):205-6, 209-12, 215-8, passim. [Medline].

  24. Wolter JM. Management of a sore throat. Antibiotics are no longer appropriate. Aust Fam Physician. 1998 Apr. 27(4):279-81. [Medline].

  25. Yoda K, Sata T, Kurata T, et al. Oropharyngotonsillitis associated with nonprimary Epstein-Barr virus infection. Arch Otolaryngol Head Neck Surg. 2000 Feb. 126(2):185-93. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.