Symptomatic treatment of acute pharyngitis in adults
- Wendy Stead, MD
Wendy Stead, MD
- Assistant Professor of Medicine
- Harvard Medical School
Acute pharyngitis is one of the most common conditions encountered in office practice, accounting for 12 million ambulatory visits in the United States annually . The majority of illness causing sore throat in adults is viral. Additionally, even when treating documented bacterial pathogens such as group A Streptococcus, antibiotics contribute minimally to the speed with which symptoms of pharyngitis improve. Nonetheless, overtreatment of acute pharyngitis continues to represent a major cause of inappropriate antibiotic use .
This topic will address options for the symptomatic relief of throat pain in adults with pharyngitis. Treatment of oropharyngeal pain secondary to surgical/endoscopic procedures or chemotherapeutic agents will not be addressed. The evaluation of the adult patient with acute pharyngitis and the antibiotic treatment of streptococcal tonsillopharyngitis are discussed separately. (See "Treatment and prevention of streptococcal tonsillopharyngitis" and "Evaluation of acute pharyngitis in adults".)
Many providers have preconceptions that acquiring an antibiotic prescription is the most important priority for patients who are visiting a primary care clinic for acute sore throat, despite evidence to the contrary [3,4]. Prescribing antibiotics that are not indicated for a specific infection puts the individual at risk for antibiotic side effects and increases the community risk of bacterial resistance. Additionally, prescribing antibiotics for sore throat increases the likelihood that a patient will make return visits to medical providers for similar symptoms, presumably due to "medicalization" of a typically self-limited illness .
Observational evidence about prescribing practices for sore throat suggests that, rather than hoping specifically for an antibiotic prescription, many patients are more interested in pain relief, reassurance, and information about their illness [3,4]. A cross-sectional survey of 298 consecutive patients in Belgium who visited family physicians for acute sore throat was designed to understand the most important reasons patients presented for provider evaluation . Hope for an antibiotic ranked 11th of 13 items, with only 37.6 percent of patients rating it as very/rather important. The three most commonly reported reasons for a physician visit, all ranked as very/rather important reasons for the visit by >80 percent of patients, were:
●To establish the cause of the symptoms
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