Sore throat resident survival guide

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Sore throat Resident Survival Guide Microchapters

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mydah Sajid, MD[2]

Synonyms and keywords: An approach to sore throat in adults, Sore throat approach in adults, Approach to pharyngitis in adults, Pharyngitis in adults


Sore throat, also called as pharyngitis, is a painful sensation in the back part of the throat due to inflammation of the pharynx. It is one of the most frequent complaints among patients visiting their primary care physicians. In the United States, approximately 12 million ambulatory care visits are due to sore throat annually. The majority of cases occur in children and adolescents. The etiology is acute self- limiting viral infection in the majority of individuals. Group A streptococcal infection is the usual causative bacteria for acute pharyngitis in adults. As a physician, it is important to identify clinical signs for life-threatening airway obstruction and deep tissue infection and treat them promptly. This section provides a short and straight to the point overview of the sore throat in adults.


Common Causes


Shown below is an algorithm summarizing the diagnosis of sore throat in adults[10][11][12]:

Are there alarming clinical signs for upper airway obstruction or deep neck infection present?
Stabilize ABC and refer patient urgently to emergency or inpatient care unit.
Consider the following differential diagnosis:
* Croup
* Acute epiglottitis
Are clinical signs for viral upper respiratory infection (including conjunctivitis, coryza, cough, viral exanthem and voice hoarseness) present?
Manage patient with supportive care.
Does patient have clinical features of GAS throat infection?
Apply Centor criteria for patient's clinical signs and symptoms. Is score ≥3?
Perform Rapid antigen detection test (RADT)
Consider other viral, bacterial or noninfectious causes of sore throat. The illness is mostly self-limiting and specific tests for diagnosis are not carried out.
GAS pharyngitis confirmed - start antibiotics
Perform throat culture in patients with any of the following risk factors:


Shown below is an algorithm summarizing the treatment of sore throat in adults according to the Infectious Diseases Society of America guidelines[5][13]:

Does patient have strong clinical suspicion for viral URTI?
Is patient having symptoms suggestive of GAS pharyngitis along with positive RADT?
Manage patient with supportive care including analgesics, hot fluids, lozenges, and soft diet.

Treat patients with empirical antibiotic:

  • Preferred regimen (1): adults: penicillin V 500mg q12h PO for 10 days; children: penicillin V 250mg q12h or q8h PO for 10 days;
  • Preferred regimen (2): amoxicillin 50mg/kg (max: 1gr) qd PO or 25/mg (max: 500mg) bid;
  • Preferred regimen (2): Benzathine G penicillin 1.2mi UI single-dose IM;

If patients are allergic to penicillin:

  • Alternative regimen (1): Cephalexin 20 mg/kg/dose (max: 500mg) bid PO for 10 days
  • Alternative regimen (2): Cefadroxil 30 mg/kg (max: 1gr) qd PO for 10 days
  • Alternative regimen (3): Clindamycin 7 mg/kg/dose (max: 500mg) tid PO for 10 days
  • Alternative regimen (4): Azythromycin 12 mg/kg (max: 500mg) qd PO for 10 days
  • Alternative regimen (5): Clarithromycin 7.5 mg/kg/dose (max: 250mg) bid PO for 10 days

Provide supportive care to the patients.





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