Pharyngitis | Johns Hopkins Medicine

What is pharyngitis?

Pharyngitis — commonly known as sore throat — is an inflammation of the pharynx, resulting in a sore throat. Thus, pharyngitis is a symptom, rather than a condition. It is usually caused by viral and/or bacterial infections, such as the common cold and flu (both viral infections) or by infection with the Streptococcus bacterium (strep throat). Pharyngitis can also occur with mononucleosis (aka “mono”), a viral infection.

Fungal pharyngitis occurs in the setting of immunosuppression or chronic steroid and antibiotic use. Sometimes, allergies, such as hay fever or allergic rhinitis, can cause sore throat. Dry indoor air and chronic mouth breathing, especially in the winter, can lead to recurrent sore throat, particularly in the morning, after waking up. Muscle strain associated with voice use can cause a pain in the throat that is similar to pharyngitis. Gastroesophageal reflux disease (GERD) can lead to chronic sore throat because of stomach acid reflux irritating the throat.

What are symptoms of pharyngitis?

• Sore throat
• Dry, scratchy throat
• Pain when swallowing
• Pain when speaking

Other symptoms may be present, depending on the cause. These include fatigue, malaise, muscle aches, headache and fever — especially with the flu or other viral infections.

How is pharyngitis diagnosed?

Diagnosis requires a physical exam and laryngoscopy (scope exam in a clinic) to assess for all the possible causes of pharyngitis.

How is pharyngitis treated?

The treatment depends on the cause. Viral pharyngitis goes away on its own with salt water gargles, pain relievers and extra fluids to help alleviate the symptoms. Bacterial pharyngitis is treated with antibiotics; and fungal pharyngitis, with antifungal medications. Prompt antibiotic therapy is needed for strep throat because untreated, it can sometimes cause kidney problems and rheumatic fever, which can damage the heart valves. A full assessment in the clinic will guide treatment for other causes.

When to Call Your Doctor for Pharyngitis

Call your doctor if you notice any of the symptoms listed above. You should be seen by a doctor if your symptoms doesn’t go away in a week; if you notice swollen lymph nodes on your neck; or if you discover pus or white patches on the back of the throat, blood in the spit or phlegm; or a rash.

Learn about cobblestone throat | Ada

What is pharyngitis?

Pharyngitis, or acute pharyngitis, is an inflammation of the back of the throat, otherwise known as the pharynx. The condition generally causes pain and a sensation of scratchiness in the region of the throat, as well as difficulty swallowing. The condition is typically referred to as a sore throat.

Pharyngitis is a very common complaint, usually caused by a viral infection, or, more rarely, a bacterial infection. In the majority of cases, it will disappear within a week, though can last longer. Treatment will usually focus on managing the symptoms. However, antibiotics may be prescribed to treat the bacterial form of the condition . Generally, it is a non-serious condition, though in some instances it can cause severe symptoms or a serious infection.

Chronic pharyngitis

Pharyngitis is usually a temporary condition, lasting for roughly one week. In a small number of cases, however, a sore throat can be recurring, becoming a condition known as chronic pharyngitis. The chronic form of the condition has a variety of possible causes, including persistent infection and stomach acid reflux. If pharyngitis lasts for weeks, it is probably chronic rather than acute pharyngitis. Smoking, vaping and exposure to other forms of smoke, such as industrial or woodsmoke, can all cause a chronic sore throat.

Symptoms of acute pharyngitis

A variety of symptoms are associated with pharyngitis, with some of the most common including:

• Sore throat
• Pain or difficulty when swallowing or talking
• Swollen, sore glands in the neck or throat
• Red throat and red, swollen tonsils
• A hoarse voice
• White or grey patches on the back of the throat

A sore throat is the characteristic symptom of pharyngitis and – in some cases – may be the only symptom. A cobblestone appearance at the back of the throat, colloquially known as “cobblestone throat,” is in some cases present. This is a distinctive lumpy, irritated appearance of the back of the throat, caused by enlarged lymphatic tissue. It is visible on visual inspection. It can also be caused by a post-nasal drip, in which mucus that accumulates in the back of the nose and throat drips downward from the back of the nose.

Commonly, pharyngitis is caused by an underlying condition such as a common cold or flu. If this is the case, it may be accompanied by symptoms of these conditions, such as fever, coughing or a runny nose. If you think that you or a loved one may have a cold, flu or pharyngitis, you can start a free symptom assessment with Ada now.

Causes of acute pharyngitis

Pharyngitis is usually caused by the viruses that also cause a common cold or flu. In rare cases, the condition can be caused by bacteria. It is difficult to determine whether a case of pharyngitis has a viral or bacterial cause, since the symptoms are similar. Smoking, vaping and exposure to airborne irritants can also cause a sore throat.

Viral infection

Viral conditions that can lead to pharyngitis include:

The viruses that cause the condition are contagious, normally spread by discharge from the nose or mouth. A virus can also survive on objects or clothing and be spread in this way.

Pharyngitis and Epstein-Barr virus mononucleosis

A sore, scratchy throat is a major symptom of mononucleosis, also known as mono or glandular fever, which is caused by the Epstein-Barr virus. Mononucleosis of this kind is most common among teenagers and younger adults. Other symptoms include:

• Severe fatigue
• Appetite loss
• Fever
• Muscle pain
• Swollen lymph nodes

Some people may also develop a rash. Tonsillitis can often occur in mononucleosis.

HIV-related pharyngitis

In acute HIV infection, pharyngitis is a common symptom. The symptoms of pharyngitis associated with HIV infection are the same as those of mononucleosis-related pharyngitis (see above), and also often present with tonsillitis. Symptoms that may occur in people affected by pharyngitis accompanying HIV infection are:

• Fever
• Sweats
• Malaise and lethargy
• Lack of appetite
• Swollen lymph glands.

Bacterial infection, such as strep throat

A number of bacterial infections can also cause pharyngitis, most commonly Streptococcal bacteria, otherwise known as Group A streptococcus. In these cases, the condition is known as strep throat. Other bacteria that far less frequently cause pharyngitis include:

• Neisseria gonorrhoeae
• Corynebacterium
• Chlamydia pneumoniae
• Mycoplasma pneumoniae
• Group C, G or F Streptococcus

Group A streptococcus is the most common cause of tonsillitis (15-30% of cases).

Good to know: Group B streptococcus is not usually associated with strep throat or other upper respiratory tract infections. However, group B strep can cause pharyngitis, with tonsillitis and swollen lymph glands in the neck.

Pharyngitis and strep throat

Strep throat is typically spread through person-to-person contact, commonly through bacteria in saliva or nasal discharge. Symptoms and signs of strep throat include:

• A sore throat and pain when swallowing which is more severe than with a normal sore throat.
• Fever, weakness and headache.
• Nausea, vomiting and abdominal pain, especially in children.
• White or grey patches visible on the back of the throat.
• Swollen, sore glands in the neck (lymph nodes).
• A widespread red rash.

If the strep throat symptoms occur after several days of coughing and a runny nose, it’s more likely that they are the result of a viral infection rather than Group A streptococcus. If you’re concerned that you may have strep throat or tonsillitis rather than pharyngitis, you can do a free Ada symptom assessment now.

Diagnosing pharyngitis

A doctor will usually diagnose the condition through a physical examination that may include:

• A close look at the throat, ears and nasal passageway
• Checking for swollen glands
• Listening to a person’s breathing using a stethoscope

If bacterial pharyngitis is suspected, a doctor may also take a swab from the throat and have it tested for the presence of bacteria.

Pharyngitis and tonsillitis

Pharyngitis is a common symptom in tonsillitis, so much so that the condition is sometimes known as tonsillopharyngitis. Tonsillitis is a condition in which the tonsils in the throat become inflamed. It can be caused by viruses, such as the Epstein-Barr virus, or bacteria, such as Group A beta-hemolytic streptococcus or Staphylococcus aureus. Most cases of acute tonsillitis are viral, but chronic or recurring tonsillitis is usually bacterial in origin.

The symptoms of bacterial tonsillitis usually develop suddenly. They include:

• A red and swollen throat that is painful
• Fever
• Difficulty swallowing or painful swallowing
• Foul breath
• Painful lymph nodes in the neck

In viral tonsillitis, the affected person may also have:

• A headache
• An earache
• Nasal congestion or stuffiness
• A cough

Very swollen tonsils may cause airway obstruction. The symptoms of airway obstruction include:

• Breathing through the mouth
• Snoring
• Disordered breathing during sleep
• Lethargy and a general feeling of unwellness

If the affected person has difficulty opening their mouth, or their voice takes on a muffled quality as if they are speaking with a hot potato in their mouth, they may have peritonsillar abscess. This is an abscess around the region of the tonsils, and is a medical emergency, because it can cause sepsis and airway obstruction.

For more information on the symptoms and treatment of this painful throat condition, see this resource on tonsillitis. If you’re concerned that you may have strep throat or tonsillitis rather than pharyngitis, why not do a free Ada symptom assessment now?

Pharyngitis and laryngitis

Laryngitis is a condition where the larynx, or voice box, becomes inflamed due to overuse or a viral infection. The most common cause is a viral infection of the upper respiratory tract; bacterial laryngitis is rare. It is often found in conjunction with a sore throat, or pharyngitis.

Coughing is linked to laryngitis, and therefore it often occurs in conjunction with diseases such as bronchitis, pneumonia, influenza, measles, whooping cough or diphtheria.

Symptoms of laryngitis include:

• Hoarseness or other changes in voice
• Tickling sensations in the throat
• A raw throat
• An urge to clear the throat

If a severe viral infection is present, the affected person may also have:

• Fever
• Malaise
• Difficulty swallowing
• Sore throat.

In some cases, a sore throat and voice changes might be caused by laryngeal cancer. This cancer is, however, quite rare. Important risk factors include smoking and excessive alcohol consumption. Human papillomavirus infection and gastroesophageal reflux disease can also increase a person’s risk of laryngeal cancer.

For more information, see this resource on laryngitis.

Pharyngitis treatment

Most cases of pharyngitis will go away without treatment in a week or less. Antibiotics are not helpful in cases of pharyngitis caused by viral infections, and are only used in cases where a bacterial infection is lingering. Most treatment for pharyngitis can be carried out at home, using over-the-counter products.

Home remedies for pharyngitis

There are a number of ways to help manage the symptoms of the condition:

• Drinking plenty of fluids is key to avoiding dehydration, which can make the symptoms of pharyngitis worse.
• Taking over the counter painkillers, such as ibuprofen or paracetamol, is a good way of managing pain, headaches and fever. These medicines should be taken according to the instructions on the packet.
• Lozenges can be useful in easing pain.
• Other over-the-counter products, such as anesthetic sprays, which can be bought from pharmacies and stores, can also help alleviate certain symptoms.

Antibiotics for pharyngitis

Antibiotics are ineffective against viral pharyngitis, though, they may be prescribed for those with a bacterial infection.

Doctors are often reluctant to prescribe antibiotics for bacterial pharyngitis due to the fact that they are not always effective and may cause side-effects. To decide if an individual should be prescribed antibiotics, doctors will sometimes use a test known as the Centor score. They will look for:

• Pus on the tonsils
• Painful or tender glands on the neck
• The absence of a cough
• Fever

If three or more of these features are present, a doctor will often prescribe a delayed prescription, whereby antibiotics will be prescribed for two or three days in the future, to be used if symptoms have not disappeared or have gotten worse.

Pharyngitis prevention

Pharyngitis is contagious, meaning there are a number of ways to reduce the risk of contracting the condition. These include:

• Avoiding sharing utensils, food and drink
• Avoiding contact with people experiencing the condition
• Thorough and frequent washing of the hands, especially after coughing or sneezing and before eating

Complications of pharyngitis

In the vast majority of cases, pharyngitis is a relatively harmless condition that will clear quickly without complications. Very rarely, however, the condition can progress and cause complications. It can also be a warning sign for a range of more serious conditions.

Possible complications include the infection spreading from the throat to nearby locations, causing, for example, an ear infection, sinus infection or less frequently pneumonia. However, this is unlikely to happen if the pharyngitis is appropriately managed. If symptoms persist or are particularly severe, a doctor’s diagnosis should be sought.

Pharyngitis FAQs

Q: What is the difference between pharyngitis and laryngitis?
A: Pharyngitis is an inflammation of the pharynx, whereas laryngitis is an inflammation of the larynx, or the voice box. The main symptom of laryngitis is hoarseness or complete loss of the voice. Usually, treatment for both conditions is similar.

Q: What is the difference between pharyngitis and tonsillitis?
A: Pharyngitis is an inflammation of the pharynx, whereas tonsillitis is an inflammation of the tonsils, a pair of tissue masses at the rear of the throat. Symptoms of tonsillitis include soreness in the lower throat and hoarseness of the voice. Pharyngitis and tonsillitis can occur at the same time – when this occurs, the condition is referred to as pharyngotonsillitis.

Q: What is strep throat?
A: Strep throat is a bacterial sore throat caused by Streptococcal bacteria, otherwise known as group A streptococcus. The pain and difficulty swallowing experienced as a result of strep throat are typically more severe than in cases of a viral sore throat. Moreover, symptoms not associated with a viral sore throat may also be experienced. These include:

• Fever, weakness and headache.
• White or grey patches visible on the back of the throat.
• Swollen, sore glands in the neck (lymph nodes).
• A widespread red rash.
• Nausea, vomiting and abdominal pain.

Feeling unwell? Get a free symptom assessment with the Ada app.

Other names for acute pharyngitis

Sore Throat (Pharyngitis): Causes & Treatments

Overview

What is sore throat?

When your throat is irritated, inflamed, scratchy, painful, or very dry, it’s called sore throat. Your throat can be sore from a bacterial or viral infection, allergies or irritants, acid reflux, vocal overuse and strain, or even sleeping with your mouth open for too long. The pain may be worse when you swallow.

Depending on what’s causing your sore throat, you can often relieve the pain and irritation by drinking warm liquids or taking throat lozenges. Sore throat caused by a viral infection usually clears up on its own after a few days of rest. A throat infection caused by bacteria is called strep throat. Your doctor can prescribe antibiotics to kill the bacteria.

Possible Causes

What causes sore throat?

Many conditions and factors cause sore throat, also called pharyngitis. You may feel pain and irritation anywhere in the back of your mouth, on your tonsils, and down your neck. You may also have a fever, swollen lymph nodes in your neck, and a headache or earache.

Common causes of a sore throat include:

• Viral infection: Most often, sore throats happen as a result of a viral infection, such as the flu or the common cold. Sore throats also occur with hand, foot, and mouth disease (caused by the Coxsackie virus) and mononucleosis (caused by the Epstein-Barr virus). Depending on the type of virus, symptoms typically go away on their own within a week to 10 days. Some viruses cause symptoms for a few months (for example, “mono”). Antibiotic medications do not work on viruses.
• Tonsillitis: Tonsils are the two small lumps of soft tissue at the back of your throat. They trap the germs that make you sick. Tonsillitis occurs when your tonsils become infected and inflamed. Bacteria and viruses can cause tonsillitis.
• Bacterial infection: Strep throat is an infection caused by a group of bacteria called group A Streptococcus. Symptoms of strep include fever and red, swollen tonsils. Your doctor can prescribe antibiotics to treat strep throat. Less common causes of bacterial sore throat include chlamydia, gonorrhea and corynbacterium.
• Allergies: Allergies to pollen, dust mites, pets, or mold can make your throat dry and scratchy. Sore throat from allergies results from postnasal drip (when mucus from your nose drips down the back of your throat). The mucus irritates your throat and causes pain.
• Acid reflux: People with a condition called gastroesophageal reflux disease (GERD) feel burning and pain in their throat. This pain, called heartburn, happens when acid from the stomach backs up into the esophagus. The esophagus is the tube that carries food from your throat to your stomach.
• Overuse or irritants: Yelling, screaming, singing without proper form, or talking too much without resting can lead to a sore throat. Spicy foods, smoking, and hot liquids can burn or irritate your throat.
• Excessive dryness: If you sleep with your mouth open at night, you may wake up with a sore throat. Being congested (clogged up) due to a cold, flu or allergies can force you to breathe through your mouth.

Less common but more serious causes of sore throat are abscess (pockets of pus around the tonsils), infection of the epiglottis (the small flap that covers the entrance to the voice box and windpipe during swallowing) and tumors.

Care and Treatment

How can I ease sore throat pain?

Treatment for a sore throat depends on the cause. Some general tips to relieve sore throat discomfort include:

• Drink warm fluids, such as hot tea with lemon or broth.
• Increase the total amount of fluids you drink. This keeps you hydrated and prevents your throat from getting dry.
• Gargle with salt water (1/4 teaspoon of salt per cup of water).
• If you are an adult, keep your throat moist with throat lozenges, ice chips, or hard candies. Do not give lozenges or hard candies to children under two years of age. They are a choking hazard. Instead, give your child a popsicle.
• Use a numbing throat spray or cold liquids to reduce pain.
• Use a humidifier or vaporizer to add moisture to rooms you spend time in, especially your bedroom when you are sleeping.
• Get plenty of rest — at least 8 hours of sleep a night.
• Ask your doctor or pharmacist about possible over-the-counter medicines to try. Never give aspirin to children because it can cause Reye’s syndrome. Do not give cough or cold medicines to children under four years of age unless your doctor tells you to.

More specific sore throat treatments based on its cause include the following:

• Bacterial infection: If you’ve tested positive for strep throat following a throat swab, your doctor will prescribe an antibiotic to clear up the infection. Common antibiotics to treat strep throat include penicillin and clindamycin. It’s important to finish the entire course of antibiotics (even if you feel better after a few doses) so the infection doesn’t return.
• Viral infection: Viruses cause most sore throats. Your doctor may recommend drinking lots of fluids, taking over-the-counter pain relievers (such as acetaminophen or ibuprofen), and getting plenty of rest. You can also try throat lozenges.
• Allergies: Over-the-counter antihistamine medication can relieve nasal congestion that causes postnasal drip.
• Acid reflux: In addition to over-the-counter antacids, lifestyle changes may relieve your heartburn and sore throat. Try sleeping on your left side with your head slightly elevated. Don’t overeat, and don’t eat right before bedtime. If your symptoms don’t improve, talk to your doctor.
• Vocal overuse: Resting your voice will allow your throat time to heal. Try not to talk as much or sing for a couple of days. You can also drink tea and other warm liquids. Avoid irritants like smoke/secondhand smoke and spicy foods because they can make your sore throat worse.

To prevent infections that cause sore throat, wash your hands often (with soap and water for at least 20 seconds or alcohol-based hand sanitizers), stay away from people who are sick and sneezing and coughing, and don’t share utensils, food or drink with people who are sick.

When to Call the Doctor

When should I call my doctor about my sore throat?

Most of the time, a sore throat isn’t a sign of a serious condition. You should call your doctor if your sore throat lasts longer than a few days. Your doctor will determine what is causing your symptoms.

See your doctor right away if you also have:

• Trouble breathing or swallowing.
• A visible bulge in the back of the throat.
• Excessive drooling (in young children).
• Blood in saliva or phlegm.
• Severe throat pain.
• Extreme tiredness.
• A fever, especially if it’s over 100.4 degrees Fahrenheit.
• Headache.
• Stomach ache, nausea/vomiting (usually in children).
• Difficulty sleeping.
• Rash anywhere on your body.
• Flu-like symptoms, such as body aches and cough.
• Pain in your ears.

Pharyngitis

Essential Infectious Disease Topics for Primary Care. 2008 : 15–24.

Guest Editor (s): Neil S. Skolnik, MD^1,2 and Ross H. Albert, MD, PhD¹

¹Abington Memorial Hospital, Jenkintown, PA USA

²Temple University School of Medicine, Philadelphia, PA USA

Adrian Wilson

Attending Physician, Westside Health, Wilmington, DE

Attending Physician, Westside Health, Wilmington, DE

Keywords: Kawasaki Disease, Sore Throat, Rheumatic Fever, Scarlet Fever, Throat Culture

Copyright © Humana Press, a part of Springer Science+Business Media, LLC 2008

This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

Introduction

One of the most common chief complaints in a primary care physician’s office is sore throat. Although a broad variety of differential diagnoses must be considered, ranging from infectious or inflammatory etiology to traumatic or neoplastic processes, the vast majority of these symptoms derive from either a viral or bacterial source. The physician must narrow the differential, decide which clinical and laboratory data may be helpful, select the most appropriate management plan for the patient’s symptoms and disease process, and prevent further complications. This chapter reviews the most common causes of pharyngitis, relevant available clinical information, appropriate laboratory tests, recommended treatment guidelines, possible complications, and general strategies for evaluating patients with acute pharyngitis.

In the 1990s, more than 6. 7 million visits with a primary complaint of sore throat were made by adults to physicians’ offices, emergency departments, or other primary care providers in the Unites States.2 Currently, acute pharyngitis accounts for approximately 2% of all primary healthcare visits for adults and 6% for children annually (more than 10 million visits).7,10 Of these cases, approximately 30% are idiopathic, 30 to 60% have a viral etiology, and 5 to 15% are caused by bacteria.8 Of the possible bacterial sources, Group A β-hemolytic streptococci (GABHS) is the most frequently isolated pathogen, causing acute pharyngitis in 5 to 15% of adults and 15 to 36% of children in the USA.4,10 Although this chapter reviews the broad range of causes of pharyngitis, the emphasis is on the diagnosis and treatment of GABHS, because this is the only common cause of sore throat that warrants antibiotic treatment.

In recent years, fear of GABHS infection and its possible complications, and growing expectation of antibiotic prescriptions by patients has resulted in overuse of antibiotics for treatment of acute pharyngitis. Reportedly, 50 to 75% of all cases of pharyngitis are currently treated with antibiotic therapy, approximately 40% of which use broad-spectrum antibiotics or antibiotics that are not indicated.7,10,14 Spurred by efforts from the Centers for Disease Control and Prevention (CDC) and Infectious Diseases Society of America (IDSA), recent guidelines have been established to decrease the frequency of unnecessary antibiotic use, and to concentrate instead on clinical protocol and appropriate laboratory evaluation.

Pathophysiology

Pharyngitis is an inflammation of the pharynx that can lead to a sore throat. Etiologic agents are passed through person-to-person contact, most likely via droplets of nasal secretions or saliva. Symptoms often manifest after an incubation period ranging from 1 to 5 days, and occur most commonly in the winter or early spring. Outbreaks of pharyngitis may occur in households or classrooms, and, infrequently, may be linked to food or animal sources.

The most common bacterial cause of pharyngitis, GABHS, is also known as Streptococcus pyogenes and may exist as single, paired, or chained gram-positive cocci. These bacteria possess protein M, a potent virulence factor that inhibits bacterial phagocytosis, as well as a hyaluronic acid capsule that enhances its ability to invade tissues. Multiple exotoxins and two hemolysins (Streptolysin S and Streptolysin O) further enhance the virulence of GABHS. Cocci may be detected on cultures (grown on blood agar), latex agglutination tests, or rapid tests using labeled monoclonal antibodies.

The viruses and other nonstreptococcal bacteria that also can cause pharyngitis are discussed in greater detail below, in the “Differential Diagnosis” section.

Clinical Presentation

History

Pharyngitis can present with sudden onset of sore throat, fever, headache, tender anterior cervical lymphadenopathy or lymphadenitis, and, occasionally, abdominal pain, nausea, vomiting, fatigue, or rash. When GABHS is the etiologic agent, fevers are often > 38.5 °C (101.3 °F), tonsillar exudates are common, and patients may experience fevers, chills, and myalgias. 8 Children may sometimes present with atypical symptoms such as abdominal pain and emesis, regardless of the cause of their pharyngitis.

Physical Exam

On examination, the typical findings of acute pharyngitis may include an erythematous and swollen pharynx, tonsillar hypertrophy and inflammation (with or without tonsillar exudates), fever, edematous uvula, petechial rash along the palate, and tender anterior cervical lymphadenopathy. Occasionally, a scarlatiniform rash may be present, often seen in association with a GABHS infection.

Clinical Guidelines

Given the above historical and physical findings, a number of clinical tools have been established to help determine whether GABHS is the likely causative pathogen. The most widely accepted of these tools is the Centor Clinical Prediction Rules for the diagnosis of GABHS in adults, which uses the presence (or absence) of four main criteria (see Table ).4,12

Table 2.1

Centor Clinical Prediction Rules

1.	Fever (by history or exam)
2.	Tender anterior cervical lymphadenopathy
3.	Presence of tonsillar exudates
4.	Absence of cough • Presence of 0–1 of the above—no further testing indicated • Presence of 2–4 of the above—GABHS testing indicated

If the patient has none or one of these symptoms, suspicion for GABHS is very low and no further testing or treatment is necessary. If the patient meets two, three, or four of the criteria, a diagnostic laboratory test is indicated. Some physicians will begin antibiotic therapy presumptively for patients with severe symptoms who meet three or four of the Centor criteria, and may not send a diagnostic test in addition to testing. The absence of three or four criteria has a negative predictive value near 80%. 4,14 The Centor Clinical Prediction Rules are endorsed by the IDSA and listed currently among the CDC recommendations online at: www.cdc/gov/drugresistance/community/files/ads/Acute_Pharyngitis.pdf.

Ultimately, the usefulness of clinical prediction rules depends on the prevalence of disease in a given community. In a GABHS-dense population, a higher score on a GABHS prediction tool would convey a higher probability of actually having a bacterial infection than in regions where overall prevalence was lower.4

Laboratory Evaluation

There is significant debate surrounding the selection of which laboratory tests are necessary to establish the correct diagnosis and ensure the appropriate treatment course for pharyngitis. Aside from influenza and new-onset HIV, the viral causes of pharyngitis only require supportive care and do not necessitate extensive testing. Of the bacterial causes, only GABHS has an indication for antibiotic therapy. Therefore, the majority of laboratory diagnostics for pharyngitis concentrate on the presence or absence of GABHS.

The gold standard of pharyngitis testing remains the throat culture, collected by swabbing the pharynx and peritonsillar region, and growing the sample on a sheep’s blood agar plate. Under ideal circumstances, and often using two samples, the sensitivity and specificity of such cultures reaches 97% and 99%, respectively.17 In most offices, however, those numbers vary widely, with a sensitivity between 30 and 90% and a specificity from 75 to 99%.8 Some false positive results can be expected with culture results because up to 20% of the US population may be chronic, asymptomatic GABHS carriers.

Another class of available tests are the rapid antigen detection (RAD) tests, which use enzyme or acid extraction from throat swabs, followed by latex agglutination, coagglutination, or enzyme-linked immunoabsorbent assay (ELISA) procedures to isolate GABHS antigen—antibody complexes.3 Although older models were not as reliable and variation still exists, newer techniques show a sensitivity ranging from 76 to 97% and a specificity > 95%. 8,17 Most modern RAD tests produce results within 10 minutes or less.

Serology may be collected for presence or absence of streptococcal antibody titers, but this information will not influence the immediate treatment of the patient’s pharyngitis symptoms. Serum titers of deoxyribonuclease B, hyaluronidase, strep-tokinase, nicotinic acid, and antistreptolysin O (ASO) may rise quickly during acute streptococcal infection (a positive ASO result reflects a fourfold increase), and will peak within 2 to 3 weeks. This information is necessary to support a diagnosis of rheumatic fever, but treatment for pharyngitis needs to begin before the return of serology laboratory results.

Both the American Academy of Pediatrics (AAP) and the American Heart Association consider a positive RAD test definitive evidence for presence of GABHS and indication for antibiotic therapy.8 The AAP also contends that when GABHS is strongly suspected, a negative RAD test should be followed up with a confirmatory throat culture. 7,8 In an adult patient, clinical suspicion should guide decisions regarding whether further confirmation of a negative RAD test is needed.

Differential Diagnosis

The differential diagnosis for sore throat symptoms is extensive. The most common viral pathogens causing pharyngitis include rhinovirus, coronavirus, adenovirus, herpes simplex virus (HSV), parainfluenza virus, influenza virus, Epstein—Barr Virus (EBV), and human immunodeficiency virus (HIV). Rhinoviruses and corona-viruses comprise more than 25% of viral cases. Acute influenza and HIV are the only viruses for which treatments with antiviral agents may improve symptoms. Otherwise, supportive treatment options are indicated for sore throat symptoms.

As discussed above in the pathophysiology section, the most common bacterial cause of pharyngitis is GABHS, occurring in 5 to 30% of cases. However, there are several other bacterial causes, including Group C streptococci, Neisseria gonorrhorea, Corynebacterium diphtheriae, Mycoplasma pneumoniae, Chlamydia pneumoniae, and Arcanobacterium haemolyticus. 3 Clinical presentation and associated signs and symptoms are important for differentiating these bacterial infections.

The patients’ clinical history and physical examination findings can help distinguish among the several viral, bacterial, and other causes of pharyngitis. Viral infections often include cough, coryza, conjunctivitis, fatigue, hoarseness, generalized body aches, abdominal pain, or diarrhea as additional symptoms. Patients with Epstein—Barr Virus (EBV) often have severe pharyngitis with tonsillar exudates, but also complain of fatigue, body aches, and systemic complaints. EBV is also associated with posterior cervical lymph adenopathy, splenomegaly, and a classic maculopa-pular rash that develops if patients receive penicillin-derived antibiotics. A patient presenting with primary HIV may complain of sore throat as well as several other flu-like symptoms, but they are likely to have HIV risk factors in their history (e.g., unprotected intercourse, multiple sexual partners, previous blood transfusion, and intravenous drug use).

Bacterial infections also have particular defining characteristics. Chlamydia pneumoniae or Mycoplasma pneumoniae can cause lower respiratory symptoms that are more severe, such as bronchitis, pneumonitis, or pneumonia, in addition to pharyngitis. Arcanobacterium haemolyticum, formerly known as Corynebacterium haemolyticum, is seen more frequently in teenagers and young adults, and may be accompanied by a scarlatiniform rash. The clinical significance of an A. haemolyticum infection remains uncertain. Reported cases of Corynebacterium diphtheriae are very rare because of childhood vaccinations, but patients with this variety of pharyngitis will frequently complain of hoarseness and stridor caused by circulation of the diphtheria exotoxin, and may also experience cervical adenitis and edema. The defining characteristic of this bacteria is the development of a firmly adherent, gray, inflammatory pseudomembrane across the oropharynx. Group C streptococci also may cause pharyngitis, but would ultimately be distinguished by a RAD test or throat culture.

In addition to the more common viral and bacterial causes of pharyngitis, a number of other causes of sore throat exist. These include Kawasaki disease, trauma or exertional irritation, neoplastic processes, abscess (such as Ludwig’s angina, para-pharyngeal or retropharyngeal, and peritonsillar), thyroiditis, gastroesophageal reflux disease (GERD), or allergy-related postnasal drip.18 Pharyngitis secondary to GERD or allergies would likely accompany symptoms of dyspepsia or nasal congestion with postnasal drip, respectively. Trauma or throat strain caused by overuse (shouting, for example) should be elicited via the patient’s history of symptom onset. Neoplastic processes can be more subtle, but may have accompanying weight loss, night sweats, fatigue, or dysphagia. An abscess would likely cause higher fevers, more discomfort, and persistent symptoms despite typical first-line antibiotic treatment. Airway compromise, hoarseness, or neck swelling may accompany abscesses depending on their location. Kawasaki disease is most common in children younger than 3 years of age, and is defined by a number of well-documented features, including pharyngeal erythema, strawberry tongue, nonpurulent conjunctivitis, fever, cervical lymphaden-opathy, cracked red lips, and erythema and swelling of the hands and feet with desquamation of periungual regions several days after symptom onset.

Treatment

Therapeutic goals for treating pharyngitis include amelioration of symptoms, decrease in contagion and transmission, prevention of complications, and, to some extent, satisfying the patient’s personal goals in the physician—patient interaction. For the vast majority of pharyngitis cases, supportive therapy purely for symptom control is the most appropriate strategy. A typical viral pharyngitis should resolve within 5 to 10 days, if not sooner. For GABHS pharyngitis, if antibacterial therapy is begun within 3 days of symptom onset, the duration of fever and pain may be shortened by approximately 1 day.4 The primary purpose of using antibiotics in GABHS pharyngitis is to avoid the development of further complications (discussed in the section below). Children with GABHS should be kept home from school until 24 hours after the initiation of antibiotic therapy.

Supportive therapy for pharyngitis includes appropriately dosed analgesic and antipyretic medicines, proper oral hydration, and rest. Acetaminophen or ibuprofen are indicated for all ages for both pain and fever control, whereas aspirin should be avoided in the pediatric population because it can increase the risk of injury to hepatic and renal structures (Reye’s Syndrome).13 Warm salt water gargles (1/4 teaspoon of salt with 8 ounces of water), soft foods, cool beverages, and frozen desserts can sooth irritated oropharyngeal tissues. Over-the-counter lozenges, sore throat drops, and throat sprays are also available to keep the affected area moisturized or anesthetized. For severe symptoms, viscous lidocaine preparations (e.g., “Magic Mouthwash”), stronger pain medicines or narcotics, or alternative modalities can be tried.

For GABHS, the above supportive measures should be combined with antibiotic therapy. Recommendations for treatment of GABHS pharyngitis have changed very little in the past decade. The CDC, the AAP, and the IDSA all agree that penicillin is the first-line agent to treat GABHS in children and adults.4,10,16 Treatment should continue for 10 days to eradicate the bacteria from the pharynx (dosing regimens are indicated in Table ). Penicillin-allergic patients should be treated with eryth-romycin or a first-generation cephalosporin. Preferred antibiotics for recurrent GABHS infection or initial treatment failure include clindamycin, amoxicillin— clavulanic acid, and penicillin G.

Table 2.2

Dosing regimens for GAHBS

Complications

For patients with acute pharyngitis, complications can develop when a bacterial source of infection is not managed properly. Most notably, GABHS is associated with suppura-tive complications, such as cervical lymphadenitis, peritonsillar or retropharyngeal abscess, mastoiditis, sinusitis, otitis media, bacteremia, endocarditis, and meningitis, as well as nonsuppurative complications, such as poststreptococcal glomerulonephritis and rheumatic fever.8 Suppurative complications develop as bacteria spreads from pharyngeal mucosal layers to deeper tissue, either directly or via hematogenous or lymphatic routes. Nonsuppurative complications are reflective of streptococcal toxins, streptolysins, and inflammatory processes involving antibodies targeted at the bacteria. GABHS is also linked to scarlet fever, myositis, impetigo, erysipelas or cellulitis, necrotizing fasciitis, and streptococcal toxic shock syndrome.

Peritonsillar and retropharyngeal abscesses form in > 1% of patients complaining of sore throat who are treated with antibiotics. The overall incidence would be even less, but patients do not always present for evaluation until complications have begun.4 Signs and symptoms related to abscess formation include a more ill-appearing patient with a “hot potato” voice, deviation of the uvula or uneven palate, and occasionally a visible fluctuant peritonsillar mass. Surgical drainage, airway management, and broader-spectrum antibiotic coverage is sometimes necessary to manage these problems effectively.

Poststreptococcal glomerulonephritis is thought to result from a reaction between circulating antibody complexes that may inappropriately bind laminin, type IV collagen, and certain proteoglycans found in the kidneys. Patients can present after a recent streptococcal illness, with hematuria, edema, and an elevated ASO titer. There is no evidence to suggest that antibiotic therapy decreases the incidence of this complication, and it occurs very infrequently.

Rheumatic fever tends to affect genetically predisposed individuals after a GABHS infection, and occurs in > 1 in 100,000 cases of GABHS pharyngitis in the United States and other developed countries.12,17 Symptoms may present within weeks and are thought to be caused by cross reactivity between antistreptococcal antibodies and sarcolemmal muscle and kidney antigens. The resultant inflammatory process can damage heart muscle and valves (especially, mitral valves), connective tissue, joints, and the central nervous system. Rheumatic fever is a clinical diagnosis made using the Jones Criteria, where either two major or one major and one minor criterion are fulfilled. Major criteria include carditis, migratory polyarthritis, Sydenham’s chorea, subcutaneous nodules, and erythema marginatum. Minor criteria include fever, arthralgia, elevated acute phase reactants, and a prolonged PR interval on EKG. Treatment involves GABHS antibiotic coverage for any subsequent pharyngitis attacks and therapy for all clinical manifestations.

Scarlet fever presents as a characteristic erythematous, blanchable “sandpaper-like” rash formed by tiny papules, and is caused by streptococcal pyrogenic exotoxins A, B, and C. Along with typical pharyngitis symptoms, the scarlatiniform rash begins on day 2 or 3 of illness on the trunk and spreads to the extremities, sparing the palms and soles. Patients may also present with circumoral pallor, strawberry tongue, and Pastia’s lines, an accentuation of the rash within skin creases. Desquamation of the palms and soles sometimes follows resolution of the scarlet fever rash on day 6 to 9 of illness.

Suggestions for Evaluation and Management

When evaluating a patient with pharyngitis and outlining a treatment plan, the initial goals of sore throat management must be kept in mind:

1. First, the differential must be addressed through history and physical exam.

2. Second, based on the above assessment, the physician must determine which laboratory tests, if any, should be carried out to ensure the proper diagnosis. The Centor Criteria is an effective clinical tool that may help guide this decision. Offering a RAD test or throat culture to those patients with two, three, or four of these criteria will help delineate which patients may need antibiotic treatment. Whether or not a second RAD or throat culture is to be used as back up to initial testing should depend on the level of clinical suspicion and prevalence of GABHS in the region. Differences in individual clinical routines will dictate whether empiric treatment is used for patients with three or four Centor Criteria, or if treatment is based on subsequent laboratory test results. Physicians must be mindful of the growing problem of antibacterial resistance in this country—patients who only fulfill one of the Centor Criteria do not need further testing and should not be given antibiotics.

3. Third, the patient’s symptoms should be alleviated. The entire range of supportive therapies, including analgesic and antipyretic medicines, oral hydration, and rest, should be considered for every patient whose symptoms warrant them. These modalities are inexpensive, easy to use, and provide an appreciable degree of comfort relief.

4. Fourth, physicians need to be vigilant for possible complications. If a patient has GABHS pharyngitis, a full 10-day course of PCN or other appropriate antibiotic must be completed to eradicate the bacteria from the pharynx and prevent rheumatic fever. One must be suspicious of symptoms that worsen or persist beyond clinical expectations.

5. Last, physicians should ensure that patients understand the medical course of their illness, and are satisfied with the assessment and treatment plan.

References

1. Bisno AL. Acute pharyngitis. The New England Journal of Medicine. 2001;18:344(3):20–211. [PubMed] [Google Scholar]2. Bisno AL. Diagnosing strep throat in the adult patient: do clinical criteria really suffice? Annals of Internal Medicine. 2003;139(2):150–151. doi: 10.7326/0003-4819-139-2-200307150-00015. [PubMed] [CrossRef] [Google Scholar]3. Bourbeau PB. Role of the microbiology laboratory in diagnosis and management of pharyngitis. Journal of Clinical Microbiology. 2003;41(8):3467–3472. doi: 10.1128/JCM.41.8.3467-3472.2003. [PMC free article] [PubMed] [CrossRef] [Google Scholar]4. Cooper RJ, Hoffman JR, Bartlett JG, et al. Principles of appropriate antibiotic use for acute pharyngitis in adults: background. Annals of Internal Medicine. 2001;134(6):509–517. doi: 10.7326/0003-4819-134-6-200103200-00019. [PubMed] [CrossRef] [Google Scholar]5. Eaton CA. What clinical features are useful in diagnosing strep throat? The Journal of Family Practice. 2001;50(3):201. [PubMed] [Google Scholar]6. Ebell MH. Strep throat. American Family Physician. 2003;68(5):937–938. [PubMed] [Google Scholar]7. Gieseker KE, Roe MH, MacKenzie T, Todd JK. Evaluating the American Academy of Pediatrics diagnostic standard for Streptococcus pyogenes pharyngitis: backup culture versus repeat rapid antigen testing. Pediatrics. 2003;111:e666–670. doi: 10.1542/peds.111.6.e666. [PubMed] [CrossRef] [Google Scholar]8. Hayes CS, Williamson JR. Management of group A beta-hemolytic streptococcal pharyngitis. American Family Physician. 2001;63(8):1557–1564. [PubMed] [Google Scholar]9. Humair JP, Revaz SA, Bovier P, Stalder H. Management of acute pharyngitis in adults: reliability of rapid streptococcal tests and clinical findings. Archives of Internal Medicine. 2006;166(6):640–644. doi: 10.1001/archinte.166.6.640. [PubMed] [CrossRef] [Google Scholar]10. Linder JA, Bates DW, Lee G, Finkelstein JA. Antibiotic treatment of children with sore throat. JAMA. 2005;294(18):2315–2322. doi: 10.1001/jama.294.18.2315. [PubMed] [CrossRef] [Google Scholar]11. McIsaac WJ, Kellner JD, Aufricht P, et al. Empirical validation of guidelines for the management of pharyngitis in children and adults. JAMA. 2004;291(13):1587–1595. doi: 10.1001/jama.291.13.1587. [PubMed] [CrossRef] [Google Scholar]12. Merrill B, Kelsberg G, Jankowski TA, Danis P. What is the most effective diagnostic evaluation of streptococcal pharyngitis? The Journal of Family Practice. 2004;53(9):734–740. [PubMed] [Google Scholar]13. Neuner JM, Hamel MB, Phillips RS, et al. Diagnosis and management of adults with pharyngitis. A cost-effective analysis. Annals of Internal Medicine. 2003;139(2):113–122. doi: 10.7326/0003-4819-139-2-200307150-00011. [PubMed] [CrossRef] [Google Scholar]14. Ressel G. Principles of Appropriate Antibiotic Use: Part I V. Acute Pharyngitis. American Family Physician. 2001;64(5):870–875. [PubMed] [Google Scholar]15. Schroeder BM. Diagnosis and management of group A streptococcal pharyngitis. American Family Physician. 2003;67(4):883–884. [PubMed] [Google Scholar]16. Snow V, Mottur-Pilson C, Cooper RJ, Hoffman JR. Principles of appropriate antibiotic use for acute pharyngitis in adults. Annals of Internal Medicine. 2001;134(6):506–508. doi: 10.7326/0003-4819-134-6-200103200-00018. [PubMed] [CrossRef] [Google Scholar]17. Vincent MT, Celestin N, Hussain AN. Pharyngitis. American Family Physician. 2004;69(6):1465–1470. [PubMed] [Google Scholar]

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Pharyngitis – StatPearls – NCBI Bookshelf

Continuing Education Activity

Pharyngitis is the inflammation of the mucous membranes of the oropharynx. In most cases, it is caused by an infection, either bacterial or viral. Other less common causes of pharyngitis include allergies, trauma, cancer, reflux, and certain toxins. This activity reviews the evaluation and treatment of patients with pharyngitis and highlights the role of the interprofessional team in the care of patients with this condition.

Objectives:

• Describe the typical presentation of pharyngitis.

• Review how to evaluate pharyngitis.

• Summarize treatment strategies for pharyngitis.

• Identify some interprofessional team strategies to improve care coordination and optimize outcomes for patients with pharyngitis.

Access free multiple choice questions on this topic.

Introduction

Pharyngitis is the inflammation of the mucous membranes of the oropharynx. In most cases, the cause is an infection, either bacterial or viral. Other less common causes of pharyngitis include allergies, trauma, cancer, reflux, and certain toxins.[1][2]

Etiology

About 50% to 80% of pharyngitis, or sore throat, symptoms are viral in origin and include a variety of viral pathogens. These pathogens are predominantly rhinovirus, influenza, adenovirus, coronavirus, and parainfluenza. Less common viral pathogens include herpes, Epstein-Barr virus, human immunodeficiency virus (HIV), and coxsackievirus. More severe cases tend to be bacterial and may develop after an initial viral infection.

The most common bacterial infection is Group A beta-hemolytic streptococci, which causes 5% to 36% of cases of acute pharyngitis. Other bacterial etiologies include Group B & C streptococci, Chlamydia pneumoniae, Mycoplasma pneumoniae, Haemophilus influenzae, Candida, Neisseria meningitidis, Neisseria gonorrhoeae, Arcanobacterium haemolyticum, Fusobacterium necrophorum, and Corynebacterium diphtheriae. Environmental allergies and chemical exposures may also cause acute pharyngitis.

Pharyngitis symptoms may also be part of the symptom complexes of other serious illnesses, including peritonsillar abscess, retropharyngeal abscess, epiglottitis, and Kawasaki disease.[3][4]

Epidemiology

In 2010, there were 1.814 million emergency department visits for pharyngitis, of which 692,000 were for patients under the age of 15. Most cases of pharyngitis occur in children under the age of 5. Adults can also develop the disorder but at a lower rate. Globally, pharyngitis rates are very high chiefly in countries where antibiotics are overprescribed.[5][6]

Pathophysiology

Bacteria and viruses can cause direct invasion of the pharyngeal mucosa. Certain viruses like rhinovirus can cause irritation secondary to nasal secretions. In almost all cases, there is a local invasion of the pharyngeal mucosa which also results in excess secretion and edema.

History and Physical

The history and physical examination should look for findings consistent with uncomplicated pharyngitis and exclude other potentially serious and life-threatening illnesses. Clinical manifestations frequently include fever, tonsillar exudates, painful cervical adenopathy, pharyngeal erythema, and ear pain. Uncomplicated infectious pharyngitis, both viral and bacterial, typically is self-limited to 5 to 7 days, is not progressive, is bilateral, does not have trismus, and does not have evidence of airway obstruction (stridor).[7] 

If viral in etiology, associated symptoms often include coughing, rhinorrhea, conjunctivitis, headache, and a rash. Group A beta-hemolytic streptococcal pharyngitis typically has an acute onset, lacks signs of a viral upper respiratory infection such as a cough or rhinorrhea, and is associated with fever, tonsillar exudates, and cervical adenopathy. Pharyngitis due to the Epstein-Barr virus, otherwise known as infectious mononucleosis,  can cause headaches, fever, tonsillar hypertrophy, lymphocytosis, and atypical lymphocytes. Myalgia and fatigue are commonly reported symptoms. Infectious mononucleosis can have both anterior and posterior cervical lymphadenopathy. Patients can have persistent lymphadenopathy and fatigue for up to 3 weeks. It is important to assess for hepatomegaly or splenomegaly. If a morbilliform rash develops after amoxicillin for presumed Group A beta-hemolytic streptococci, infectious mononucleosis should be suspected.

A retropharyngeal abscess is characterized by neck stiffness and pain with neck extension. For epiglottitis, look for stridor as a symptom. F. necrophorum is the bacterium that causes Lemierre’s syndrome, or internal jugular vein thrombophlebitis. If there has been orogenital contact by the patient, consider N. gonorrhoeae. An acute retroviral syndrome due to HIV may be associated with fever and non-exudative pharyngitis.

Evaluation

A variety of clinical decision rules have been developed to improve the diagnosis of Group A beta-hemolytic streptococcal pharyngitis and to guide testing and treatment. The Centor Score is one of the most commonly used, particularly for adult patients.[8][9]

Centor Criteria (1 point for each) for Group A Beta-hemolytic Streptococci:

1. Tonsillar exudate

2. Tender anterior cervical left mentoanterior

3. History of fever

4. Absence of a cough

More likely in 5 to 15 years of age and not valid under 3 years old.

Point Totals and Recommended Actions:

 

• 0-1: No testing or antibiotics

• 2-3: Rapid antigen test

• 4: No testing, empiric antibiotics

White blood cell counts have minimal value in the differentiation of viral versus bacterial etiologies of pharyngitis. A lymphocytosis (greater than 50%) or increased atypical lymphocytes (greater than 10%) may suggest infectious mononucleosis.

Rapid antigen detection tests (RADT) are very specific for Group A beta-hemolytic streptococci, but their sensitivity varies widely, from about 70% to 90%. If the test is positive, treatment should be initiated. If it is negative, particularly in children, a throat culture should be obtained and should guide treatment.

Throat cultures have been the ideal standard for diagnosis, but their sensitivity is variable and is influenced by many factors. These factors include the bacterial burden, site of collection (the tonsillar surface is best), culture medium, and culture atmosphere.

A heterophile antibody or monospot test is 70% to 92% sensitive and 96% to 100% specific. This test for infectious mononucleosis is commonly available, but the ideal standard is to use Epstein-Barr virus serology. The test’s sensitivity is lessened by testing early in the course of the illness (1 to 2 weeks) and by the age of the patient (less than 12 years).

For gonococcal detection, a culture should be obtained. Thayer-Martin agar is most commonly used. For Candida, test with a potassium hydroxide preparation or Sabouraud agar. 

A chest X-ray is not needed for routine cases. If airway compromise is suspected, a lateral neck X-ray should be obtained.

A computed tomography (CT) scan may help identify a peritonsillar abscess.

Treatment / Management

Antibiotics for pharyngitis are usually used for patients with Group A beta-hemolytic streptococcal pharyngitis. Antibiotics may shorten the duration of symptoms by 16 to 24 hours and prevent rheumatic fever, which older data suggest occur in 1 in 400 untreated cases of strep pharyngitis. Antibiotics should only be used for Group A beta-hemolytic streptococci-positive patients, particularly if they are children, based on a positive culture or a rapid antigen detection test. A 10-day course of oral penicillin is recommended to ensure the eradication of bacterial carriage and the prevention of rheumatic fever.[1][10][11][12]

Treatment options for Group A beta-hemolytic streptococcal pharyngitis include oral treatment with penicillin V or oral amoxicillin. Cephalosporins, macrolides, and clindamycin may also be used. Intramuscular penicillin is also a treatment option. Resistance may develop during treatment with azithromycin and clarithromycin, and it is not considered a first-line antibiotic for this indication. In patients with a mild penicillin allergy, cephalosporins can be used. In patients with a history of anaphylaxis to penicillin, azithromycin or clindamycin can be used. The disease is no longer infectious after 24 hours of antibiotics.[13]

Single-dose corticosteroids like dexamethasone may be given to reduce the severity of symptoms, although the evidence for this approach is limited. Symptomatic treatment with gargles and acetaminophen or nonsteroidal anti-inflammatory drugs should be recommended. Use caution in the setting of severe dehydration. For patients with infectious mononucleosis, contact sports should be avoided for 6 to 8 weeks due to the risk of splenic rupture.

Differential Diagnosis

• Airway obstruction from any cause

• Allergic rhinitis

• Cancer of the head and neck

• Gastroesophageal reflux disease

• Peritonsillar abscess

• Diphtheria

• Epiglottitis

• Herpes simplex virus

• Mononucleosis

Prognosis

In general, the prognosis for pharyngitis is good as both viral and bacterial infections are typically self-limited to 5 to 7 days.

In developing countries, over 20 million individuals are affected by group A streptococci and develop acute rheumatic fever. This disorder is the leading cause of death in young people.  Mortality from pharyngitis is rare but does occur if the airway is compromised.

Most cases of pharyngitis resolve within 7 to 10 days. Treatment failures are usually due to antibiotic resistance, poor compliance, and untreated close contacts.

Complications

Complications of bacterial pharyngitis include:

Postoperative and Rehabilitation Care

Household members of patients with group A streptococci should be treated with a full 10-day course of antibiotics without any prior testing only if they present with symptoms. Asymptomatic individuals require no treatment.

Deterrence and Patient Education

Patients and parents should be educated on the differences between bacterial and viral pharyngitis. Patients diagnosed with group A streptococcus infection should be encouraged to complete a full course of antibiotics to prevent the risk of rheumatic heart disease. Patients with viral pharyngitis should be instructed to treat the symptoms with OTC pain relievers and that there is no need for antibiotics. This will help to decrease antibiotic overprescribing and bacterial drug resistance. All patients with pharyngitis should be educated on the importance of handwashing, rest, and hydration.

Pearls and Other Issues

Antibiotics are typically overused in the treatment of acute pharyngitis. As most cases are due to a viral etiology, and antibiotics will not alter the patient’s course.

Enhancing Healthcare Team Outcomes

The management of pharyngitis is best accomplished with an interprofessional team approach. Once the patient is diagnosed and treated, follow-up is required by the nurse, pharmacist, or healthcare provider. Follow-up cultures are not necessary for patients without symptoms. All patients with pharyngitis should be educated on the use of antibiotics. Patients should be told not to use antibiotics empirically as the cause is most often viral. Hand washing and maintenance of good personal hygiene is important to prevent spread to others in the home. To prevent recurrence, immunization should be recommended against the flu virus and diphtheria. All patients must be told about the importance of compliance with antibiotic treatment. Further, patients should be told to use salt water gargles and adhere to a liquid diet until the symptoms subside. If the patient has a fever or pain, acetaminophen is recommended. Finally, parents should be told not to give young children aspirin for fever.[14][15] [Level 5]

Outcomes

The majority of pharyngitis cases recover spontaneously within 7-10 days. Failures may occur if the cause is bacterial and antibiotics were either never prescribed, or there was the presence of antibiotic resistance, or there was a lack of patient compliance with treatment. Most cases of streptococcal pharyngitis improve within 24-48 hours of treatment. However, the flu-like symptoms may persist for 5-10 days. Mortality in the US is very rare but can occur from upper airway obstruction. Complications from pharyngitis are reported in less than 1% of patients and may include otitis media, pneumonia, nephritis, and meningitis.[16][17] [Level 5]

References

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8.

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11.

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Diagnosis and Treatment of Streptococcal Pharyngitis

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3. Danchin MH,
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7. McIsaac WJ,
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8. Ebell MH.
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9. McIsaac WJ,
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10. Gerber MA.
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11. Ezike EN,
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2005;159(5)486–490.

12. Neuner JM,
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13. Mirza A,
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2007;46(3)241–246.

14. Gerber MA,
Tanz RR,
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et al.
Optical immunoassay test for group A beta-hemolytic streptococcal pharyngitis. An office-based, multicenter investigation. JAMA.
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15. Van Howe RS,
Kusnier LP II.
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16. Fischer P.
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17. Shulman ST,
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So what’s wrong with penicillin for strep throat? Pediatrics.
2004;113(6)1816–1819.

18. Cooper RJ,
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et al.,
for the American Academy of Family Physicians, American College of Physicians, American Society of Internal Medicine, Centers for Disease Control and Prevention.
Principles of appropriate antibiotic use for acute pharyngitis in adults: background. Ann Intern Med.
2001;134(6)509–517.

19. American Academy of Pediatrics, Committee on Infectious Diseases. Red Book. 26th ed. Elk Grove Village, Ill.: American Academy of Pediatrics; 2003:578–580.

20. Dajani A,
Taubert K,
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Treatment of acute streptococcal pharyngitis and prevention of rheumatic fever: a statement for health professionals. Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young, the American Heart Association. Pediatrics.
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21. Centor RM,
Allison JJ,
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2007;22(1)127–130.

22. Del Mar CB,
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2006;(4):CD000023.

23. Merrill B,
Kelsberg G,
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2004;53(9)734–740.

24. Cooper RJ,
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et al.,
for the Centers for Disease Control and Prevention.
Principles of appropriate antibiotic use for acute pharyngitis in adults: background. Ann Emerg Med.
2001;37(6)711–719.

25. Rimoin AW,
Hamza HS,
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et al.
Evaluation of the WHO clinical decision rule for streptococcal pharyngitis. Arch Dis Child.
2005;90(10)1066–1070.

26. Sharland M,
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et al.
Antibiotic prescribing in general practice and hospital admissions for peritonsillar abscess, mastoiditis, and rheumatic fever in children: time trend analysis. BMJ.
2005;331(7512)328–329.

27. Snellman LW,
Stang HJ,
Stang JM,
Johnson DR,
Kaplan EL.
Duration of positive throat cultures for group A streptococci after initiation of antibiotic therapy. Pediatrics.
1993;91(6)1166–1170.

28. Kaplan EL,
Johnson DR,
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Susceptibility of group A beta-hemolytic streptococci to thirteen antibiotics: examination of 301 strains isolated in the United States between 1994 and 1997. Pediatr Infect Dis J.
1999;18(12)1069–1072.

29. Casey JR.
Selecting the optimal antibiotic in the treatment of group A beta-hemolytic streptococci pharyngitis. Clin Pediatr (Phila).
2007;46(suppl 1)25S–35S.

30. Feder HM Jr,
Gerber MA,
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Once-daily therapy for streptococcal pharyngitis with amoxicillin. Pediatrics.
1999;103(1)47–51.

31. Clegg HW,
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Treatment of streptococcal pharyngitis with once-daily compared with twice-daily amoxicillin: a non-inferiority trial. Pediatr Infect Dis J.
2006;25(9)761–767.

32. Martin JM,
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2002;346(16)1200–1206.

33. Marcy SM.
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2007;46(suppl 1)36S–45S.

34. Casey JR,
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Meta-analysis of cephalosporin versus penicillin treatment of group A streptococcal tonsillopharyngitis in children. Pediatrics.
2004;113(4)866–882.

35. Linder JA,
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2006;166(13)1374–1379.

36. Bisno AL.
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2003;139(2)150–151.

37. McIsaac WJ,
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2004;291(13)1587–1595.

38. Sheeler RD,
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Accuracy of rapid strep testing in patients who have had recent streptococcal pharyngitis. J Am Board Fam Pract.
2002;15(4)261–265.

39. Tanz RR,
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2007;26(2)175–176.

40. Paradise JL,
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2002;110(1 pt 1)7–15.

41. Burton MJ,
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1999;(3):CD001802.

42. Orvidas LJ,
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2006;116(11)1946–1950.

Tonsillopharyngitis – Ear, Nose, and Throat Disorders

Tonsillectomy has often been considered if GABHS tonsillitis recurs repeatedly (> 6 episodes/year, > 4 episodes/year for 2 years, or > 3 episodes/year for 3 years) or if acute infection is severe and persistent despite antibiotics. Other criteria for tonsillectomy include obstructive sleep disorder, recurrent peritonsillar abscess, and suspicion of cancer. (See also American Academy of Otolaryngology–Head and Neck Surgery Clinical Practice Guideline: Tonsillectomy in Children [Update].) Decisions should be individual, based on patient age, multiple risk factors, and response to infection recurrences (2 Treatment references Tonsillopharyngitis is acute infection of the pharynx, palatine tonsils, or both. Symptoms may include sore throat, dysphagia, cervical lymphadenopathy, and fever. Diagnosis is clinical, supplemented… read more ).

Numerous effective surgical techniques are used to perform tonsillectomy, including electrocautery dissection, microdebrider, radiofrequency coblation, and sharp dissection. Significant intraoperative or postoperative bleeding occurs in 2% of patients, usually within 24 hours of surgery or after 7 days, when the eschar detaches. Patients with bleeding should go to the hospital. If bleeding continues on arrival, patients generally are examined in the operating room, and hemostasis is obtained. Any clot present in the tonsillar fossa is removed, and patients are observed for 24 hours. Postoperative IV rehydration is necessary in ≤ 3% of patients, possibly in fewer patients with use of optimal preoperative hydration, perioperative antibiotics, analgesics, and corticosteroids.

Postoperative airway obstruction occurs most frequently in children 2 years who have preexisting severe obstructive sleep disorders and in patients who are morbidly obese or have neurologic disorders, craniofacial anomalies, or significant preoperative obstructive sleep apnea. Complications are generally more common and serious among adults. Accumulating evidence suggests that tonsillotomy (partial intracapsular removal of tonsil tissue), when done to treat various disorders is as efficacious as traditional tonsillectomy and preferable because of better outcomes related to pain, postoperative complications, and patient satisfaction (3 Treatment references Tonsillopharyngitis is acute infection of the pharynx, palatine tonsils, or both. Symptoms may include sore throat, dysphagia, cervical lymphadenopathy, and fever. Diagnosis is clinical, supplemented… read more ).

90,000 how is it manifested and how to treat it?

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90,000 Chronic pharyngitis: treatment, symptoms, causes

25.08.2021

126 234

8 minutes

Contents:

What is chronic pharyngitis
Causes of chronic pharyngitis
Symptoms of chronic pharyngitis
Course of the disease
Can chronic pharyngitis be cured?
What a doctor can prescribe for the treatment of chronic pharyngitis

Almost constant discomfort in the throat associated with chronic pharyngitis is experienced by about 7% of Russians ¹ .Let’s figure out why this disease occurs and whether it is possible to get rid of its obsessive symptoms.

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What is chronic pharyngitis

Chronic pharyngitis is a long-term inflammatory disease with a predominant lesion of the pharyngeal mucosa ³ . Since the pharynx is part of the upper respiratory tract, and there is no clear boundary between the nasal cavity, pharynx and larynx, the inflammatory process can spread from top to bottom, causing the development of nasopharyngitis (inflammation of the nasopharynx), tonsillopharyngitis (inflammation of the pharynx and tonsils) and pharyngolaryngitis (inflammation of the pharynx and larynx ) ^1.4 .

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Causes of chronic pharyngitis

Inflammation of the pharynx can be caused by various infectious and non-infectious factors ¹ .

Infectious causes

Among the infectious causes of chronic pharyngitis:

1. Viruses. Cause 70% of acute pharyngitis. The most common causative agents of the disease are rhinoviruses, as well as adenoviruses, influenza and parainfluenza viruses. Infecting the pharynx, the virus often paves the way for bacterial infection ¹ .
2. Bacteria. The leading role belongs to the β-hemolytic streptococcus of group A. It is during examination that it is found in 17% of adults and in 15-30% of children with chronic pharyngitis. In the vast majority of cases, the disease is caused by associations of two or three microorganisms ^1,2,3 .

Non-infectious causes

The development of chronic pharyngitis and the appearance of its symptoms in adults is facilitated by:

1. Allergens – plant pollen, house dust, food, hygiene products and other substances that get on the mucous membrane of the pharynx.

2. Injuries of the pharynx – thermal (too cold or hot food), mechanical (damage to the mucous membrane by foreign bodies) or chemical (drinks, drugs).
3. Chronic nasal congestion – leads to impaired nasal breathing, forces to breathe through the mouth, often and long-term use of vasoconstrictor drugs. In the treatment of chronic pharyngitis, in this case, it is very important to achieve the restoration of nasal breathing.
4. “Postnasal leakage syndrome” – the release of pathological mucus from the nasal cavity or paranasal sinuses and its flow down the back of the pharynx.
5. Diseases of the gastrointestinal tract – GERD (gastroesophageal reflux disease), in which acidic contents of the stomach are constantly thrown into the pharynx.
6. Diseases of the heart and blood vessels, endocrine system, accompanied by metabolic disorders in the tissues of the respiratory tract ¹ .

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Symptoms of chronic pharyngitis

The disease proceeds cyclically: periods of exacerbation are replaced by remission when the disease subsides.Symptoms of exacerbation of chronic pharyngitis do not differ from those observed in acute form ¹ .

In case of illness, the following symptoms appear:

• Discomfort in the throat, sensation of dryness and perspiration.
• Severe pain when swallowing, which may radiate to the ear or lower jaw.
• Feeling of a “lump of mucus” in the throat, provoking a superficial cough.
• Slight swelling and tenderness of the cervical lymph nodes.
• Normal or low-grade fever, which does not exceed 38 ⁰ C and is not accompanied by chills and weakness.
• Sleep disorder associated with the need to swallow mucus that collects on the back of the throat.
• Fatigue combined with daytime sleepiness, irritability and decreased concentration ¹ .

Examination of the throat in chronic pharyngitis helps to identify objective signs of the disease – redness of the mucous membrane, enlargement of the tonsils and other lymphoid formations of the pharynx. Moreover, no signs of angina are observed at the same time ¹ .

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Course of the disease

Long-term inflammation of the pharynx can take various forms:

• chronic catarrhal pharyngitis;
• subatrophic (atrophic) pharyngitis;
• hypertrophic (granular) pharyngitis ^1.2.4 .

Catarrhal inflammation is the easiest variant of the development of events. It is manifested by reddening of the tissues of the pharynx, a scratching sensation, dryness and sore throat ⁴ .

Atrophic processes lead to thinning of the mucous membrane. The pharynx becomes dry and shiny, dilated blood vessels are visible on its surface. Dryness of the mucous membrane leads to the appearance of a painful cough ⁴ .

With hypertrophic pharyngitis, the mucous membrane of the pharynx thickens. Lymphatic and blood vessels dilate, the mucous membrane swells, and small rounded formations appear on it – accumulations of lymphocytes ^1.2.4 .

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Can chronic pharyngitis be cured?

The disease is difficult to treat if irreversible changes have occurred in the mucous membrane.To restore the function of the mucous membrane, you need to see a doctor in time. If it is possible to establish the cause of the inflammation and choose the right treatment, remission of the disease can be achieved. Otherwise, pharyngitis can lead to complications:

• damage to the lower respiratory tract;
• Inflammation of the paranasal sinuses and middle ear;
• rheumatism; 90 095 90 092 glomerulonephritis; 90 095 90 092 psoriasis;
• arthritis ¹ .

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What a doctor can prescribe for the treatment of chronic pharyngitis

Pharyngitis at the initial stages of its development is dealt with by otorhinolaryngologists (ENT doctors), but the help of immunologists is often required.In chronic granular pharyngitis, treatment may include surgery – removal of the enlarged lymphoid tissue of the pharynx ¹ .

Complex treatment of pharyngitis may include:

• antibiotics – in case of bacterial, especially streptococcal infection;
• antihistamines – with severe swelling of the pharyngeal mucosa and the allergic nature of the disease;
• immunotropic drugs that enhance the body’s natural defenses;
• vitamin and mineral complex preparations ¹ .

Topical treatment includes solutions and sprays, lozenges and lozenges with antiseptic, antimicrobial, antiviral, anti-inflammatory and analgesic effects ¹ .

For throat irrigation, the doctor may recommend the HEXORAL ^® spray based on hexetidine, a broad-spectrum antiseptic that is active against bacteria and some viruses that cause inflammation of the respiratory tract ^5.6 .The drug is allowed to be used not only in the treatment of chronic pharyngitis in adults, but also for local therapy of the disease in children from the age of three ⁶ .

For rinsing the throat, HEXORAL ^® solution based on hexetidine with the addition of essential oils can be used on the recommendation of a doctor from the age of three ⁶ .

Lozenges with neutral mint flavor HEXORAL ^® TABS based on chlorhexidine and benzocaine can be suitable for both adults and children over 4 years old ⁶ .

HEXORAL ^® TABS CLASSIC with orange, black currant, lemon and honey flavors is produced for adults and children over 6 years of age. It is based on the antiseptic amylmetacresol ⁶ . HEXORAL ^® TABS EXTRA may be suitable for children over 12 years old and for adults. The lidocaine it contains can relieve even severe sore throat ⁶ .

In conclusion, let us add: to get rid of the symptoms of chronic pharyngitis, it is necessary to eliminate the provoking and causal factors.It is important to give up cigarettes and alcohol, protect the respiratory tract from polluted air and treat associated diseases with specialists ¹ .

The information in this article is for guidance only and does not replace professional medical advice. Consult a qualified professional for diagnosis and treatment.

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Literature

1. Gostry A.V., Mikhailova N.A., Simonova A.V. Chronic pharyngitis: etiology, pathogenesis, treatment. New approaches to the assessment of etiopathogenesis // Archives of Internal Medicine. -2019. – No. 1. – P. 32-43.
2. A.V. Gurov, M.A. Yushkina, O.A. Guseva Local therapy of inflammatory diseases of the oropharynx // Difficult patient №3, VOL. 16, 2018, p. 41-46.
3. S. Ya.Kosyakov, I.B. Angotoeva. Non-infectious causes of chronic pharyngitis. Medical Council, No. 20, 2018, pp. 112-115.
4. Sobolev V.P., Karpova O.Yu., Artamonova P.C. New treatment options for inflammatory diseases of the pharynx. // Consilium Medicum. 2018; 20 (11): 30-32.
5. Deryabin P.G. Study of the antiviral properties of the drug “hexoral” in vitro against a number of viruses that cause acute respiratory infections and herpes [Electronic resource] / P.G. Deryabin, G.A. Galegov // Bulletin of Experimental Biology and Medicine. – 2015. – No. 9. – S. 72-75.
6. Instructions for use of the drug HEXORAL ^® aerosol: https: //www.hexoral.ru / preparaty / spray
7. Instructions for use of the drug HEXORAL ^® solution: https://www.hexoral.ru/preparaty/rastvor
8. Instructions for use of the drug HEXORAL ^® TABS: https: //www.hexoral. ru / preparaty / tabs
9. Instructions for use of the drug HEXORAL ^® CLASSIC: https://www.hexoral.ru/preparaty/tabs-classic
10. Instructions for use of the drug HEXORAL ^® TABS EXTRA: https: // www .hexoral.ru / preparaty / tabs-extra

causes, symptoms, diagnosis, prevention, treatment

Pharyngitis is a chronic inflammatory process that develops in the pharynx, first affecting the mucous membrane, later and deeper tissues, including the soft palate and lymph nodes.This disease, even with serious complications, cannot be life-threatening. Moreover, it is very common, and it can be extremely difficult to completely cure certain forms of pharyngitis.

Signs and symptoms of pharyngitis

The first sign of the possible development of pharyngitis is the appearance of painful and unpleasant sensations in the throat: burning, perspiration, tickling, tingling.In the morning, a person gets rid of the accumulation of mucus that accumulates overnight by coughing up or coughing up, this is a common procedure. If pharyngitis occurs, it can lead to nausea and further vomiting. In addition, people begin to complain of pain while swallowing food.

The severity of the symptoms of the disease largely depends on the form of pharyngitis, as well as its etiology. In most cases, the pathology is accompanied by such symptoms? how:

• hyperemia of the mucous membrane of the throat in human pharyngitis;
• granularity of pharyngeal lymphoid fluids;
• also on the back of the pharynx, on the palatine tonsils, small purulent formations may appear;
• general weakness of the body;
• frequent headaches that can last for a long period of time;
• Frequent persistent, dry cough;
• body temperature may rise within 37.5 degrees;
• muscle pain.

If chronic pharyngitis is an adjunct to existing diseases, then its symptoms are added to those of the underlying disease.

Often with pharyngitis, there is an increase in the submandibular and occipital lymph nodes. If you press on them at this moment, this leads to severe pain. The fact that the infection has spread to the middle ear may indicate the occurrence of the effect of congestion and pain in the ears.

Quite often, acute pharyngitis, which develops in a child, is confused with other diseases, such as measles or scarlet fever.Also, its primary symptoms are in many ways similar to other sore throat disease. However, in the case of angina, all the signs are more pronounced: a high temperature up to 39 degrees, as well as severe pain in the throat. Many experts point out that the symptoms of pharyngitis are similar to those of diphtheria. The difference in this case is the absence of a painful gray-white film that forms on the mucous membrane of the throat with diphtheria.

Neurological disorders, which, however, may indicate another pathology, are also important signs of the disease.Therefore, in order to establish an accurate diagnosis, the patient should consult an ENT doctor.

In JSC “Medicine” (Clinic of Academician Roitberg), experienced doctors will be able to provide the patient with the necessary consultations, examinations, and will also offer him effective treatment. The clinic is equipped with the latest technology, which allows doctors to quickly diagnose and begin therapy. The clinic is located in the Central Administrative District at 2nd Tverskoy-Yamskaya per 10.

Do you have symptoms of pharyngitis?

Only a doctor can accurately diagnose the disease.Do not delay the consultation – call by phone

+7 (495) 775-73-60

Causes of the appearance and development of pharyngitis

Medical practice shows that the main reason for the development of acute and later chronic pharyngitis is most often the inhalation of too cold or polluted air by a person, and the occurrence of the disease can also be accompanied by the effect on the mucous membrane of irritants of various types.Therefore, experts divide this disease by etiological types:

• Infectious pharyngitis. Viruses and bacteria become the cause of its development;
• traumatic can develop with trauma to the mucous membrane, during operations or when foreign objects enter the pharynx;
• allergic.

A variety of reasons can lead to the development of acute pharyngitis, including smoking and drinking alcohol, inhalation of chemical vapors, dust, hot steam, and radiation.

Also, pharyngitis can develop as a side disease against the background of other pathologies. For example, it often forms with caries, sinusitis, sinusitis.

Chronic pharyngitis is often a continuation of the acute form of the disease and is rarely diagnosed as an independent pathology. In addition to him, the patient may experience diseases such as disorders of the gastrointestinal tract, gastritis, pancreatitis, cholecystitis. Also, bad habits or surgery (removal of tonsils) can lead to chronic pharyngitis.In addition, chronic pharyngitis can develop against the background of elements of the contents of the stomach entering the pharynx, a similar effect can occur if a person has diseases such as a hernia of the esophagus. Among the main reasons for the development of pharyngitis, it is worth highlighting:

• breathing problems and diseases of the nasopharynx (sinusitis) caused by trauma;
• human use of medicinal vasoconstrictor drugs.

In the process of development of chronic pharyngitis, inflammation of the mucous membrane occurs, which covers the larynx, which in turn leads to frequent colds.Contribute to the development of the disease and all kinds of infectious pathologies, inflammation of the pharynx, tonsils (tonsillitis).

Ways of infection with pharyngitis

Infection with pharyngitis can occur against a background of viral infections that affect a person’s throat. Including such diseases can contribute to this:

• various types of colds, flu;
• angina, diphtheria;
• fungal infections.

Most of these diseases are transmitted by airborne droplets, which means that a person can become infected with them by simply breathing air or contacting other people who are already infected. In the future, against the background of colds, flu, tonsillitis, pharyngitis develops, which is initially difficult to diagnose. Only an examination by a specialist will make it possible to timely identify the ailment and begin its treatment.

What complications can the disease cause

As mentioned above, pharyngitis itself does not pose a serious danger to human life.However, if the disease gets worse, it can lead to serious health risks. For example, if the disease is not treated and becomes neglected, then eventually a person may develop hypersensitivity to various infections and pathogens. Streptococcal pharyngitis can cause the development of purulent and non-purulent complications. Let’s consider each of these options.

• Non-purulent complications (rheumatism) lead to the formation of nodules of inflammation in various tissues, including the heart, the musculoskeletal system.Experts call this complication post-streptococcal glomerulonephritis.
• Purulent complications (peritonsillar or pharyngeal abscess). In the case of the development of this form of complication of pharyngitis, there is a real threat to the patient’s life. If effective treatment is not carried out, the pathology can develop into sepsis (blood poisoning).

Also, the initial pharyngitis in the future can cause such serious health problems:

• inflammation of the lymph nodes located in the neck (cervical lymphadenitis), this disease is especially difficult in adults;
• sialoadenitis or inflammation of the salivary gland, the treatment of such a pathology often requires surgery;
• Inflammation of the auditory tubes and middle ear, can lead to complete or partial hearing loss;
• laryngitis inflammation inside the larynx can also lead to serious consequences;
• tracheitis – an inflammation of the tracheal mucosa is a provocateur of bronchitis and pneumonia with the transition to pneumonia;
• chronic bronchitis – in this case, the infection from the larynx passes into the lungs, treatment will require the use of strong antibiotics.

It is also important to remember that often the cause of chronic pharyngitis is initially untreated strep throat.

When to see a doctor

Pharyngitis is a disease that is quite difficult to determine in the early stages.Therefore, if a person experiences pain when swallowing food, or he feels constant slight ailments, the temperature rises, it is not worth stalling for time, it is better to immediately consult a specialist. He will be able to carry out the necessary examination and make an accurate diagnosis. If there is no pharyngitis, and a person has a simple cold or sore throat, then he will be prescribed one course of treatment. If the ENT doctor can determine the signs of pharyngitis, then the earlier he starts therapy, the better and more effective it will be on the patient.

Pharyngitis diagnosis

Pharyngitis is diagnosed by an ENT doctor. To begin with, he interviews the patient and examines him. Further, the necessary tests are taken, including bacteriological sowing of the throat to clarify the nature of the infection.During the examination, the doctor pays special attention to the mucous membrane of the throat, in what condition it is. After the diagnosis is made, the doctor determines the form of treatment.

How is the disease being treated

Pharyngitis treatment largely depends on its form (acute or chronic).It includes medical care when the patient is given medications of various properties, including:

• immune stimulants;
• pain relievers;

90 092 heat-reducing;

• antibiotics;
• anti-inflammatory drugs.

In addition, the patient will have to use all kinds of rinses. In the chronic form of the disease, in addition to drug treatment, various procedures and physiotherapy are also prescribed.

Home treatment

It is not recommended to treat pharyngitis at home without first consulting a doctor. After the examination, the doctor can prescribe various rinses to the patient, which he can do himself, at home.

Disease prevention

As a prevention of pharyngitis, experts recommend leading a healthy lifestyle, giving up bad habits (especially smoking, drinking alcohol), taking vitamins, and tempering.

How to make an appointment with a specialist

You can sign up for a qualified ENT specialist using the online form on the clinic’s website and by phone +7 (495) 775-73-60. The clinic is located in the central district of Moscow at the address: 2nd Tverskoy-Yamskaya per, 10 (Belorusskaya metro station or Mayakovskaya metro station).

Here, an experienced doctor will be able to explain to the patient whether it is necessary to take antibiotics for pharyngitis, what is atrophic pharyngitis or granular pharyngitis.

90,000 What is pharyngitis, its types and symptoms. General principles of treatment

Symptoms and treatment of pharyngitis in children and adults

Pharyngitis is an inflammatory process of the pharyngeal mucosa, characterized by specific symptoms.It can proceed in acute and chronic form, has different types. You need to know the symptoms of pharyngitis in adults and children in order to diagnose the disease in a timely manner and begin treatment.

The main symptoms of pharyngitis

The most striking symptom of the disease is pain in the throat, which becomes more intense when swallowing. Also noted:

• increase in body temperature;
• persistent sore throat;
• Increased fatigue and weakness.

Often there are painful, uncomfortable sensations in the ears. Another important symptom is a cough that produces a small amount of sputum. This symptom is inherent in chronic pharyngitis, and sputum is constantly present on the back of the pharynx – the patient swallows it, which leads to even greater irritation of the mucous membrane.

When examining the patient’s throat, the doctor can differentiate the types of the inflammatory process:

• granular pharyngitis – small bulges form on the back of the pharynx, the surface of the mucous membrane is red;
• acute – the pharynx is red, there is a slight whitish coating;
• chronic – loose mucosa, slightly reddish, single rashes may be present;
• atrophic – thinned mucosa, may be grayish-white.

Treatment of pharyngitis in children and adults

If inflammation of the pharynx is mild and the general well-being of the patient remains practically unchanged, then minimal therapeutic measures will be sufficient. For example, inhalation with pharyngitis without increasing body temperature, gargling with decoctions of medicinal herbs and a solution of baking soda. Recommendations for the treatment of various types of pharyngeal inflammation:

1. How to cure granular pharyngitis.With this type of inflammation, a high body temperature is always present. Therefore, first, the patient undergoes symptomatic therapy – antipyretic drugs, non-steroidal inflammatory drugs are prescribed. In parallel, local treatment is carried out – irrigation of the mucous membrane, lubricating it with antiseptic agents, rinsing.
2. Acute pharyngitis. He always develops aggressively. The patient complains of unbearable pain in the throat, paroxysmal cough, high body temperature. It is advisable for such a disease to immediately prescribe intensive therapy.Antibiotics for acute pharyngitis are the only effective prescription.
3. How to treat chronic pharyngitis. Drug therapy is prescribed only during periods of exacerbation of the pathology. During remission, the patient should carry out prophylaxis – periodic rinsing of the throat with a decoction of chamomile or sage, taking vitamins, drinking tea with viburnum and raspberries. With proper prevention, exacerbations occur extremely rarely.
4. Treatment of pharyngitis in children proceeds without prescribing antibiotics.At this age, the inflammation is acute, but mild. Conventional inhalations (if there is no fever), rinsing and treating the mucous membrane with antiseptic solutions literally on the second or third day normalize the child’s condition.

Many are interested in how to treat cough with pharyngitis in adults. This symptom often indicates a chronic inflammatory process, so the treatment will be prolonged. The most effective tablets and lozenges are Faringosept, Strepsils, Septolete.At the same time, Lugol spray helps relieve pain and relieve coughing.

There are a number of types of pharyngitis that require treatment in a hospital. For example, if viruses are the cause of the development of inflammation of the pharynx. In this case, a laboratory examination of a smear from the pharyngeal mucosa will be required. This will help identify the true causative agent of the pathology and prescribe competent therapy. Treatments for viral pharyngitis are selected on an individual basis. The treatment is carried out within 15-21 days.Since these are antibacterial drugs, it is necessary to monitor the state of the intestinal microflora.

Possible complications

The most common complication is the transformation of an acute form of pharyngitis into a chronic one. But if the signs of the disease are ignored, competent therapy is not carried out, then development is possible:

• retropharyngeal abscess – often diagnosed if the throat with atrophic pharyngitis was not treated with antiseptics and was not restored after an exacerbation of the disease;
• laryngitis;
• chronic bronchitis;
• rheumatism of the joint – a complication of viral pharyngitis;
• tracheitis.

All data on the variants of the course of inflammation of the pharynx, the differences between subatrophic pharyngitis and other types of the disease can be obtained on our website https://www.dobrobut.com/.

Related services:
Consultation of an otolaryngologist
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Acute pharyngitis | Doctor MOM®

Contents:
Causes of pharyngitis
Symptoms of pharyngitis
Complications of acute pharyngitis
How to treat acute pharyngitis?

Acute pharyngitis is an infectious disease, the symptoms of which are associated with inflammation of the mucous membranes of the pharynx.

CAUSES OF PHARYNGITIS:

• Bacteria. Bacterial pharyngitis can occur with an increase in the activity of opportunistic flora that inhabits the mucous membranes of the respiratory tract. These are the most common causative agents of acute pharyngitis: pneumococci, streptococci, staphylococci. Much less often bacterial pharyngitis is caused by specific types of infection: corynebacterium diphtheria, treponema pallidum, etc.

• Viruses. Viral pharyngitis often occurs during the cold season.This is due to the fact that in late autumn and winter, optimal temperature conditions are created for the existence and transmission of influenza viruses, adenovirus infection, parainfluenza, etc.

• Fungi. Fungal pharyngitis is a typical complication of immunodeficiency conditions. Candida yeast fungi are found in a large number of healthy people – this is due to the fact that normal immunity suppresses the growth of fungi and does not allow the development of an inflammatory process.In cases of haphazard antibiotic treatment, long-term use of corticosteroids, in congenital and acquired immunodeficiency conditions, the protective function of the mucous membranes of the respiratory tract is suppressed, and the risk of developing fungal pharyngitis increases.

Pharyngitis is considered a “winter” disease and is often associated with hypothermia, although this is not entirely true. The inflammation is caused by pathogens. However, hypothermia, exposure to tobacco smoke, stress are factors that predispose to the onset of illness due to a deterioration in the blood supply to the mucous membranes and an increase in their vulnerability to microbes.

SYMPTOMS OF ACUTE PHARYNGITIS:

• Sore throat . Uncomfortable sensations can be different: from mild perspiration to acute pain. Often, the discomfort is exacerbated by swallowing, talking, opening the mouth.

• Cough or cough. Coughing is a more common symptom for pharyngitis. Cough develops when pharyngitis is combined with laryngitis, tracheitis or bronchitis.

• Temperature rise. With bacterial pharyngitis, the temperature rises gradually, lasts 4-5 days and also gradually decreases. With viral diseases, the temperature rises quickly, children may have a fever up to 39 ° and higher. In this case, the high temperature lasts 2-3 days.

• Symptoms of intoxication. The severity of general manifestations in the form of muscle aches, lower back, headache, loss of appetite and general weakness also varies significantly and depends on the causative agent of the disease.Strong signs of intoxication are characteristic of influenza, adenovirus infection, streptococcal sore throat in combination with pharyngitis.

COMPLICATIONS OF ACUTE PHARYNGITIS

If untreated, complications may develop:

• Transition of acute pharyngitis into chronic . This situation is typical for “untreated” bacterial pharyngitis. For example, the use of antibiotics in an insufficient dose or too short a course causes bacterial resistance.They adapt to existence on mucous membranes, acquire the ability to evade the body’s defenses. The infection becomes chronic with periods of remission, which are followed by exacerbations.

• Acute bronchitis. If the inflammatory process spreads to the lower respiratory tract, inflammation of the bronchi develops. In this case, the cough intensifies, purulent sputum may appear. Children often develop bronchospasm.

• Pneumonia .Inflammation equally often becomes a complication of viral and bacterial infections in weakened people: old people, young children, pregnant women, as well as people with immunodeficiency states and chronic respiratory diseases.

HOW TO TREAT ACUTE PHARYNGITIS

• Creation of a favorable microclimate. This is air humidification, which is especially important in the cold season, when central heating is on. Humidifiers or water tanks located near the heaters will help to increase the humidity.It is also necessary to regularly ventilate the room, avoid tobacco smoke.

• Complete rest. Adequate sleep (at least 8 hours) in a well-ventilated room, refusal of excessive physical and emotional stress, will help restore health faster.

• Medicines for the treatment of pharyngitis.
• Herbal Cough Lozenges Dr. IOM ^® . This is a medicine that helps in the treatment of strep throat if it is accompanied by a cough.Lozenges contain plant extracts in precisely selected dosages, which have an analgesic, anti-inflammatory, antiseptic effect on the mucous membranes of the pharynx. At the same time, their irritation decreases, which makes it possible to relieve uncomfortable sensations (pain, perspiration, “scratching”, etc.). Lozenges are used in the treatment of acute pharyngitis in adults.
• Syrup Doctor IOM ^® . This is a good solution in cases where strep throat is accompanied by tracheitis or bronchitis, with a dry or unproductive cough.The syrup contains extracts of medicinal plants that have mucolytic, bronchodilator, anti-inflammatory and expectorant effects. Herbal ingredients help to improve the discharge of phlegm, expand the bronchi, which means they bring relief from coughing. Syrup DOCTOR MOM ^® can be used in children from 3 years of age and in adults.
• Ointment Doctor IOM ^® Phyto. Ointment with essential oils helps to relieve headache and muscle pain, nasal congestion.The drug can be used in adults and children from 3 years of age.

Acute pharyngitis is a common illness that affects adults and children. Preparations from the Doctor MOM ^® line can be an excellent addition to your home medicine cabinet.

You may also be interested in:

Pharyngitis – acute and chronic. Pharyngitis symptoms and treatment.

If you have pain, dryness, perspiration, sensation of a “lump” in the throat, painful swallowing, then most likely this is an inflammation of the mucous membrane of the posterior pharyngeal wall – pharyngitis .The throat with pharyngitis is red, inflamed.

Treatment of this disease should be started as early as possible, when the first symptoms appear. This will help avoid serious complications. Experienced otolaryngologists, candidates and doctors of medical sciences conduct daily appointments in our clinic.

Why pharyngitis is dangerous

Untimely treatment of pharyngitis is dangerous for the transition of the disease to a chronic form and serious complications, including sinusitis, sinusitis, otitis media, kidney inflammation (glomerulonephritis), etc.But the most formidable of the possible consequences is rheumatic lesions of the heart and joints.

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Diagnostics of pharyngitis in MedicCity

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Diagnostics of pharyngitis in MedicCity

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Diagnostics of pharyngitis in MedicCity

Treatment of pharyngitis should be carried out only under the supervision of an ENT doctor! Acute pharyngitis may be the first manifestation of infectious diseases (measles, rubella, scarlet fever), requiring a different treatment regimen than with pharyngitis.

Chronic pharyngitis may not be an independent disease, but a manifestation of chronic gastritis, cholecystitis, pancreatitis and other gastrointestinal pathology.In gastroesophageal reflux disease, for example, it is not uncommon for acidic gastric contents to enter the pharynx during sleep, which causes the development of chronic catarrhal pharyngitis . Until the root cause of the disease is eliminated, local treatment in this case will not give results.

Reasons for the development of the disease

Common causes of pharyngitis are inhalation of cold or polluted air, the effect of chemical irritations (alcohol, tobacco).

Infectious pharyngitis can be caused by various microbes (strepto-, staphylo-, pneumococci), viruses (influenza, adenovirus) and fungi (candida). The disease can also develop as a result of the spread of infection from any nearby focus of inflammation (for example, sinusitis, rhinitis, dental caries).

Difficulty nasal breathing, abuse of vasoconstrictor drops can also provoke pharyngitis.

Symptoms of pharyngitis can be present in the so-called postnasal syndrome (English term – “postnasal drip”), when the constant drainage of pathological secretions from the nasal cavity or paranasal sinuses along the back of the throat causes discomfort, sore throat.This condition may be accompanied by wheezing, therefore it is necessary to carry out differential diagnosis with bronchial asthma.

Classification of pharyngitis

The disease can occur in the acute form and chronic form.

Acute pharyngitis develops as a result of exposure to the mucous membrane of the pharynx of an aggressive factor (infection, chemicals, etc.). The course of the disease is favorable.

Chronic pharyngitis can develop as a consequence of untreated acute pharyngitis or be an independent disease resulting from prolonged irritation of the pharyngeal mucosa. The course of chronic pharyngitis is characterized by phases of exacerbation and remission.

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Throat sanitation

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Diagnostics of pharyngitis in MedicCity

Pharyngitis symptoms

Pharyngitis symptoms (acute and chronic) are similar, but there are still slight differences:

Acute pharyngitis

• painful sensation when swallowing;
• less often – general malaise, fever;
• Possible irradiation of pain in the ears.

Chronic pharyngitis

• dry, sore throat;
• Sensation of a lump in the throat, which makes you want to clear your throat;
• dry cough.

Pharyngitis in children

Pharyngitis in children is easy to recognize. Pharyngitis symptoms in children may be as follows. The child complains of scratching and sore throat, it is difficult for him to swallow, he coughs. The posterior wall of the pharynx is red, all in small tubercles, but the tonsils on both sides of the tongue are normal, pink and clean.With pharyngitis, the child has weakness, headache and sore throat, lack of appetite, difficulty swallowing.

Acute pharyngitis is more common in babies and adolescents. Usually, acute pharyngitis occurs against the background of colds.

Treatment of pharyngitis in children

How to treat pharyngitis in children? Before starting treatment, you need to establish the cause of the disease. Then remove too hot and cold food, cold drinks (especially soda) from the child’s diet, refrain from spicy, salty and solid foods.

You can make warming compresses on the neck, warm the baby’s feet, drink warm milk with honey and butter. Gargle with a decoction of chamomile, oak bark and other anti-inflammatory herbs.

Pharyngitis in adults

Unlike children, adults most often have chronic pharyngitis.

Patients are worried about pain, dryness and sore throat, it is difficult for them to swallow, they often want to cough, but the contents are badly coughing up. With chronic pharyngitis, the head hurts, sleep worsens, and general weakness is noted.

The main causes of pharyngitis are:

• untreated colds; 90 095 90 092 remaining caries in the mouth; 90 095 90 092 smoking; 90 095 90 092 frequent stress;
• weakened immunity;
• drinking cold (straight from the refrigerator) and too hot drinks; 90 095 90 092 uncontrolled medication intake;
• allergy;
• Poor ecology and work in unhealthy production.

Treatment of pharyngitis

In the treatment of pharyngitis, a qualified diagnosis is required, including examination by an otorhinolaryngologist, a smear from the oropharynx for flora with determination of sensitivity to antibiotics and bacteriophages, as well as, if necessary, consultation of a gastroenterologist, general and biochemical blood analysis, general urine analysis, ultrasound abdominal cavity.

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Laboratory diagnostics at MedicCity

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Laboratory diagnostics at MedicCity

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Laboratory diagnostics at MedicCity

Pharyngitis treatment includes general measures and local therapy .

General measures

It is necessary to reorganize the upper respiratory tract and oral cavity – to eliminate adenoids, rhinitis, curvature of the nasal septum, sinusitis, caries, etc. It is also important to cure gastrointestinal diseases, which are often the cause of pharyngitis.

Also prescribed are funds aimed at enhancing immunity (hardening procedures, vitamin therapy, etc.).

It is recommended to reduce the impact of negative environmental factors on the pharyngeal mucosa (smoking, dust, chemicals, etc.).

Local treatment

Drug therapy includes antibiotic therapy according to indications, irrigation of the pharynx with drugs, lubrication of the mucous membrane of the posterior pharyngeal wall, etc.

Alkaline, oil-alkaline, herbal inhalations are very effective against pharyngitis.It is also important to carry out frequent rinsing of the throat with antiseptic solutions (the patient can carry out them at home on their own).

The course of treatment for chronic pharyngitis usually includes 10-14 treatment procedures carried out daily or every other day. It is also recommended to carry out supportive treatments 2-3 times a year.

Remember that tobacco smoke, strong alcohol, household dust, cold air can exacerbate chronic pharyngitis! Refuse during the period of illness from drinking and smoking, as well as walking in cold damp weather!

In case of pharyngitis, treatment should only be prescribed by an otolaryngologist! Medicines bought at random or on the recommendation of friends may turn out to be useless or harm your health!

How to cure pharyngitis at home in adults and children

Inflammation that affects the pharyngeal mucosa and adjacent tissues is called pharyngitis.
Symptoms of the disease are similar to ARVI:

• Sore throat;
• Soreness when swallowing;
• Swelling of the pharynx;
• Dry cough;
• General weakness, malaise, fever, enlargement of adjacent lymph nodes.

When examined by a specialist, inflammation, swelling, and the presence of purulent plaque are revealed. After confirmation of the diagnosis, treatment of pharyngitis at home is allowed, carried out until complete recovery of both adult patients and children.

Fig. 1. Signs of pharyngitis.

Forms, types and causes of pharyngitis

The main cause of the onset of the disease is hypothermia of the larynx, which occurs when inhaling cold air. Also, pathology can occur with a viral infection in the oral cavity, in the presence of pathogenic microorganisms (staphylococci, streptococci), Candida fungi, chemicals in the throat, too hot or cold food.

Granular pharyngitis can be the result of the patient’s professional work (singers, teachers, guides, announcers, commentators).There is also an allergic form of pharyngitis, which manifests itself as a reaction to certain foods or substances, insect bites and pollen. Allergic pharyngitis is considered a seasonal disease and, in addition to the therapy itself, requires the obligatory elimination of the irritating factor.

According to the form of the course of the disease, it can be divided into acute and chronic phases:

• Acute pharyngitis is characterized by more pronounced symptoms observed with an aggressive effect of the infection on the patient’s pharynx;
• Chronic pharyngitis manifests itself periodically, and is a consequence of ignoring the disease in its acute phase.

Fig. 2. Stages of chronic pharyngitis.

Treatment of acute pharyngitis in a child – methods and approaches

The acute phase occurs with the direct effect of viruses or bacteria on the tissue of the pharynx, has pronounced symptoms. The disease develops faster in a combination of several factors: the ingress of pathogenic flora into the pharynx and its sudden hypothermia.

A common example is a child eating snow or ignoring throat protectors during the cold season.In children, the disease is dangerous with many serious complications, catarrhal pharyngitis can become chronic, provoke inflammatory processes in the nose and ears.

Treatment of acute pharyngitis consists in the need to eliminate the arisen focus of inflammation and prevent the likelihood of relapse. The disease is treated with medication and hardware methods, in particular, FUF devices are used for direct exposure to ultraviolet radiation on the inflammation focus.

How to treat pharyngitis at home? Advantages of using the “Solnyshko” irradiators.

The disease is characterized by seasonality, more often occurs in cold, damp weather. Outpatient treatment involves visiting clinics, performing procedures with the need to get home afterwards, at risk of new hypothermia and infection of the pharynx. Therefore, the treatment of atrophic pharyngitis and other forms of the disease is best done at home, using medicines and specialized equipment.

Devices manufactured by the Solnyshko company (OUFk-01, OUFd-01, OUF-06, OUFv-02, OUFb-04) effectively affect the pathogenic flora of the pharyngeal mucosa. After the first session, the patient will feel serious relief, it will become easier to swallow food and speak. Treatment of acute pharyngitis at the appearance of the first symptoms of the disease is much faster, thanks to the use of hardware methods. The healing process takes less time, and the risk of complications is minimized.

Bacterial streptococcal pharyngitis with the apparatus method of treatment implies a direct effect on the source of infection, as a result of which recovery occurs after several procedures. In the treatment of chronic pharyngitis at home, the use of “Sun” devices is also relevant. The devices are shown as preventive use for people whose professions involve the need to talk a lot. Periodic use of the device helps prevent the development of infection in the pharynx.

“Solnyshko” irradiators are suitable for the prevention and treatment of any form of pharyngitis in both adults and children. You can choose a suitable device in our Catalog.

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