Medication Summary
The goal of pharmacotherapy is primarily to reduce morbidity. Analgesics/antipyretics and topical anesthetics are mainstay of pharmacological treatment. Most of these agents have been available for many years and are available without prescription.
A 2010 prospective, randomized, double-blind, placebo-controlled, multicenter study [22] showed that patients with viral pharyngitis who received chlorhexidine gluconate/benzydamine hydrochloride mouth spray reported less pain on both Day 3 and Day 7. Further, recipients of chlorhexidine/benzydamine reported a significantly better quality of life on Day 7. Chlorhexidine/benzydamine was well tolerated, and no serious adverse events were observed during this trial.
Analgesics/antipyretics
Class Summary
These agents are often helpful in relieving the pain and fever associated with pharyngitis.
Acetaminophen (Tylenol)
Relieves pain by elevation of the pain threshold. Reduces fever by acting directly on hypothalamic heat-regulating centers, which increases dissipation of body heat via vasodilation and sweating.
Ibuprofen (Advil, Motrin)
Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.
Topical Anesthetics
Class Summary
These agents soothe irritated or inflamed mucous membranes associated with sore throat.
Benzocaine (Trocaine, Benzocol, Cylex, Cepacol Maximum Strength)
Lozenges or gargle reduces pain associated with pharyngitis. Inhibits neuronal membrane depolarization, blocking nerve impulses.
Antiviral Agents
Class Summary
These agents are used specifically to treat viral infections. They are available for only a few viruses.
Amantadine (Symmetrel)
Active against influenza A virus. Has little or no activity against influenza B virus isolates. Mechanism of antiviral action is unclear. Prevents release of infectious viral nucleic acid into the host cell by interfering with the function of the transmembrane domain of the viral M2 protein. In certain cases, known to prevent virus assembly during virus replication. Treatment begun within 48 h of the onset of symptoms decreases the duration of fever and other symptoms.
Rimantadine (Flumadine)
Inhibits viral replication of influenza A virus H1N1, H2N2, and H3N2 with little or no activity against influenza B virus. Prevents penetration of the virus into the host by inhibiting uncoating of influenza A. Does not appear to interfere with the immunogenicity of inactivated influenza A vaccine. Can be used together during an outbreak.
Oseltamivir (Tamiflu)
Inhibits neuraminidase, which is a glycoprotein on the surface of influenza virus that destroys an infected cell's receptor for viral hemagglutinin. By inhibiting viral neuraminidase, decreases release of viruses from infected cells and thus viral spread. Effective to treat influenza A or B. Start within 40 h of symptom onset. Available as capsules and an oral suspension.
Acyclovir (Zovirax)
Synthetic purine nucleoside analogue with in vitro and in vivo inhibitory activity against HSV-1, HSV-2, and VSV. Inhibitory activity is highly selective because of its affinity for the enzyme thymidine kinase (TK) encoded by HSV and VZV.
Valacyclovir (Valtrex)
Prodrug rapidly converted to the active drug acyclovir. More expensive but has a more convenient dosing regimen than acyclovir.
Famciclovir (Famvir)
Prodrug that when biotransformed into active metabolite, penciclovir, may inhibit viral DNA synthesis/replication.
Antiviral Agent, Inhalation Therapy
Zanamivir (Relenza)
Inhibitor of neuraminidase, which is a glycoprotein on the surface of the influenza virus that destroys the infected cell's receptor for viral hemagglutinin. By inhibiting viral neuraminidase, release of viruses from infected cells and viral spread are decreased. Effective against both influenza A and B. To be inhaled through Diskhaler oral inhalation device. Circular foil discs containing 5-mg blisters of drug are inserted into supplied inhalation device.
