Pharyngitis medical therapy
Pharyngitis medical therapy On the Web
American Roentgen Ray Society Images of Pharyngitis medical therapy
Risk calculators and risk factors for Pharyngitis medical therapy
Editor-In-Chief: C. Michael Gibson, M.S., M.D. ; Associate Editor(s)-in-Chief: Chetan Lokhande, M.B.B.S , Venkata Sivakrishna Kumar Pulivarthi M.B.B.S 
The majority of cases of pharyngitis are self-limited and only require symptomatic therapy. Accurate diagnosis of streptococcal pharyngitis followed by appropriate antimicrobial therapy is important for the prevention of acute rheumatic fever, for the prevention of suppurative complications (e.g, peritonsillar abscess, cervical lymphadenitis, mastoiditis, and, possibly, other invasive infections), to improve clinical symptoms and signs, for the rapid decrease in contagiousness, for the reduction in transmission of GAS to family members, classmates, and other close contacts of the patient to allow for the rapid resumption of usual activities; and for the minimization of potential adverse effects of inappropriate antimicrobial therapy.
- Acute pharyngitis should be treated according to the etiologic agent.
- As viral infections are the most common causes of pharyngitis in children, most patients do not require treatment and only need supportive care.
- Bacterial pharyngitis is common among young children and adolescents. Group A streptococcal pharyngitis is the only common form of the disease for which antimicrobial therapy is definitely indicated. Therefore, when a clinician evaluates a patient with an acute sore throat, the most important clinical task is to decide whether or not the patient has “strep throat.”
Corticosteroids have been studied and recommended by a guideline, but results were heterogeneous in a meta-analysis.
The most recent trial in the meta-analysis showed:
- Insignificant benefit in the primary outcome at 24 hours. Risk difference of 4.7% (95% CI, −1.8% to 11.2%)
- Significant benefit at the secondary outcome of 48 hours. Risk difference of 8.7% (95% CI, 1.2% to 16.2%)
Other Treatment Regimen
|Supportive Therapies||Systemic Therapy||Antimicrobial Regimens|
Other bacterial pharyngitis
Chronic Carriers of Group A Streptococci
Antimicrobial therapy is not indicated for the majority of chronic carriers. A few conditions where antibiotics are recommended are:
- An outbreak of rheumatic fever, acute poststreptococcal glomerulonephritis or invasive GAS infection
- Closed community outbreak of GAS pharyngitis
- Family history of acute rheumatic fever
- Excessive anxiety about rheumatic fever
- ↑ Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G et al. (2012) Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis 55 (10):1279-82. DOI:10.1093/cid/cis847 PMID: 23091044
- ↑ Bisno AL (1996) Acute pharyngitis: etiology and diagnosis. Pediatrics 97 (6 Pt 2):949-54. PMID: 8637780
- ↑ 3.0 3.1 3.2 3.3 3.4 Bisno AL (2001) Acute pharyngitis. N Engl J Med 344 (3):205-11. DOI:10.1056/NEJM200101183440308 PMID: 11172144
- ↑ Aertgeerts B, Agoritsas T, Siemieniuk RAC, Burgers J, Bekkering GE, Merglen A; et al. (2017). "Corticosteroids for sore throat: a clinical practice guideline". BMJ. 358: j4090. doi:10.1136/bmj.j4090. PMID 28931507. ACPJC review
- ↑ Sadeghirad B, Siemieniuk RAC, Brignardello-Petersen R, Papola D, Lytvyn L, Vandvik PO; et al. (2017). "Corticosteroids for treatment of sore throat: systematic review and meta-analysis of randomised trials". BMJ. 358: j3887. doi:10.1136/bmj.j3887. PMC 5605780. PMID 28931508.
- ↑ Hayward GN, Hay AD, Moore MV, Jawad S, Williams N, Voysey M; et al. (2017). "Effect of Oral Dexamethasone Without Immediate Antibiotics vs Placebo on Acute Sore Throat in Adults: A Randomized Clinical Trial". JAMA. 317 (15): 1535–1543. doi:10.1001/jama.2017.3417. PMC 5470351. PMID 28418482. Review in: Ann Intern Med. 2017 Aug 15;167(4):JC16
- ↑ Patel SK, Ghufoor K, Jayaraj SM, McPartlin DW, Philpott J (1999) Pictorial assessment of the delivery of oropharyngeal rinse versus oropharyngeal spray. J Laryngol Otol 113 (12):1092-4. PMID: 10767923
- ↑ Hess GP, Walson PD (1988) Seizures secondary to oral viscous lidocaine. Ann Emerg Med 17 (7):725-7. PMID: 3382075
- ↑ Gonzalez del Rey J, Wason S, Druckenbrod RW (1994) Lidocaine overdose: another preventable case? Pediatr Emerg Care 10 (6):344-6. PMID: 7899121
- ↑ Turnbull RS (1995) Benzydamine Hydrochloride (Tantum) in the management of oral inflammatory conditions. J Can Dent Assoc 61 (2):127-34. PMID: 7600413
- ↑ Passàli D, Volonté M, Passàli GC, Damiani V, Bellussi L, MISTRAL Italian Study Group (2001) Efficacy and safety of ketoprofen lysine salt mouthwash versus benzydamine hydrochloride mouthwash in acute pharyngeal inflammation: a randomized, single-blind study. Clin Ther 23 (9):1508-18. PMID: 11589263
- ↑ Cingi C, Songu M, Ural A, Erdogmus N, Yildirim M, Cakli H et al. (2011) Effect of chlorhexidine gluconate and benzydamine hydrochloride mouth spray on clinical signs and quality of life of patients with streptococcal tonsillopharyngitis: a multicentre, prospective, randomized, double-blinded, placebo-controlled study. J Laryngol Otol 125 (6):620-5. DOI:10.1017/S0022215111000065 PMID: 21310101
- ↑ Cingi C, Songu M, Ural A, Yildirim M, Erdogmus N, Bal C (2010) 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 89 (11):546-9. PMID: 21086279
- ↑ Watson N, Nimmo WS, Christian J, Charlesworth A, Speight J, Miller K (2000) Relief of sore throat with the anti-inflammatory throat lozenge flurbiprofen 8.75 mg: a randomised, double-blind, placebo-controlled study of efficacy and safety. Int J Clin Pract 54 (8):490-6. PMID: 11198725
- ↑ Weckmann G, Hauptmann-Voß A, Baumeister SE, Klötzer C, Chenot JF (2017). "Efficacy of AMC/DCBA lozenges for sore throat: A systematic review and meta-analysis". Int J Clin Pract. doi:10.1111/ijcp.13002. PMID 28869700.
- ↑ Thomas M, Del Mar C, Glasziou P (2000) How effective are treatments other than antibiotics for acute sore throat? Br J Gen Pract 50 (459):817-20. PMID: 11127175
- ↑ Gehanno P, Dreiser RL, Ionescu E, Gold M, Liu JM (2003) Lowest effective single dose of diclofenac for antipyretic and analgesic effects in acute febrile sore throat. Clin Drug Investig 23 (4):263-71. PMID: 17535039
- ↑ Olympia RP, Khine H, Avner JR (2005) Effectiveness of oral dexamethasone in the treatment of moderate to severe pharyngitis in children. Arch Pediatr Adolesc Med 159 (3):278-82. DOI:10.1001/archpedi.159.3.278 PMID: 15753273
- ↑ O'Brien JF, Meade JL, Falk JL (1993) Dexamethasone as adjuvant therapy for severe acute pharyngitis. Ann Emerg Med 22 (2):212-5. PMID: 8427434
- ↑ Bulloch B, Kabani A, Tenenbein M (2003) Oral dexamethasone for the treatment of pain in children with acute pharyngitis: a randomized, double-blind, placebo-controlled trial. Ann Emerg Med 41 (5):601-8. DOI:10.1067/mem.2003.136 PMID: 12712025