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 treated in office practice, with millions of visits annually in the United States .
This topic will address options for the symptomatic relief of throat pain in adults with acute pharyngitis of viral (the most common cause of infectious sore throat in adults) or bacterial etiology.
The evaluation of the adult patient with acute pharyngitis, the antibiotic treatment of streptococcal tonsillopharyngitis, the diagnosis and treatment of season influenza, and issues specific to pharyngitis due to mononucleosis are discussed separately. (See "Evaluation of acute pharyngitis in adults" and "Treatment and prevention of streptococcal tonsillopharyngitis" and "Diagnosis of seasonal influenza in adults" and "Treatment of seasonal influenza in adults" and "Clinical manifestations and treatment of Epstein-Barr virus infection".)
The evaluation and treatment of less common but serious causes of sore throat including epiglottitis, peritonsillar abscess, submandibular and retropharyngeal space infections, and acute human immunodeficiency virus (HIV) infection, are discussed separately. (See "Evaluation of acute pharyngitis in adults", section on 'Excluding dangerous conditions' and "Evaluation of acute pharyngitis in adults", section on 'Non-infectious causes' and "Epiglottitis (supraglottitis): Clinical features and diagnosis" and "Epiglottitis (supraglottitis): Management" and "Peritonsillar cellulitis and abscess" and "Deep neck space infections" and "Acute and early HIV infection: Clinical manifestations and diagnosis".)
Most adult patients with acute pharyngitis have a viral illness for which they are seeking relief of sore throat pain, which is important for patient comfort and improves the patient’s ability to remain appropriately hydrated. A discussion of options for pain relief should accompany the evaluation for the etiology of the throat pain, which is most likely to be a self-limiting virus, less likely a bacterium requiring antibiotics (eg, Streptococcus or gonococcus) , and much less likely, a very serious infection (eg, epiglottitis, peritonsillar abscess, deep space infections, or acute human immunodeficiency virus [HIV]).
- Schappert SM, Rechtsteiner EA. Ambulatory medical care utilization estimates for 2006. Natl Health Stat Report 2008; :1.
- Harris AM, Hicks LA, Qaseem A, High Value Care Task Force of the American College of Physicians and for the Centers for Disease Control and Prevention. Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults: Advice for High-Value Care From the American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med 2016; 164:425.
- Little P, Gould C, Williamson I, et al. Reattendance and complications in a randomised trial of prescribing strategies for sore throat: the medicalising effect of prescribing antibiotics. BMJ 1997; 315:350.
- Del Mar CB, Glasziou PP, Spinks AB. Antibiotics for sore throat. Cochrane Database Syst Rev 2006; :CD000023.
- Butler CC, Rollnick S, Pill R, et al. Understanding the culture of prescribing: qualitative study of general practitioners' and patients' perceptions of antibiotics for sore throats. BMJ 1998; 317:637.
- van Driel ML, De Sutter A, Deveugele M, et al. Are sore throat patients who hope for antibiotics actually asking for pain relief? Ann Fam Med 2006; 4:494.
- Mangione-Smith R, Zhou C, Robinson JD, et al. Communication practices and antibiotic use for acute respiratory tract infections in children. Ann Fam Med 2015; 13:221.
- Schachtel BP, Fillingim JM, Thoden WR, et al. Sore throat pain in the evaluation of mild analgesics. Clin Pharmacol Ther 1988; 44:704.
- Lala I, Leech P, Montgomery L, Bhagat K. Use of a simple pain model to evaluate analgesic activity of ibuprofen versus paracetamol. East Afr Med J 2000; 77:504.
- Shulman ST, Bisno AL, Clegg HW, et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis 2012; 55:1279.
- Eccles R, Loose I, Jawad M, Nyman L. Effects of acetylsalicylic acid on sore throat pain and other pain symptoms associated with acute upper respiratory tract infection. Pain Med 2003; 4:118.
- Schachtel BP, Fillingim JM, Lane AC, et al. Caffeine as an analgesic adjuvant. A double-blind study comparing aspirin with caffeine to aspirin and placebo in patients with sore throat. Arch Intern Med 1991; 151:733.
- Korb K, Scherer M, Chenot JF. Steroids as adjuvant therapy for acute pharyngitis in ambulatory patients: a systematic review. Ann Fam Med 2010; 8:58.
- Thomas M, Del Mar C, Glasziou P. How effective are treatments other than antibiotics for acute sore throat? Br J Gen Pract 2000; 50:817.
- Schachtel BP, Cleves GS, Konerman JP, et al. A placebo-controlled model to assay the onset of action of nonprescription-strength analgesic drugs. Clin Pharmacol Ther 1994; 55:464.
- Boureau F, Pelen F, Verriere F, et al. Evaluation of Ibuprofen vs Paracetamol analgesic activity using a sore throat pain model. Clin Drug Investig 1999; 17:1.
- Voelker M, Schachtel BP, Cooper SA, Gatoulis SC. Efficacy of disintegrating aspirin in two different models for acute mild-to-moderate pain: sore throat pain and dental pain. Inflammopharmacology 2016; 24:43.
- Burnett I, Schachtel B, Sanner K, et al. Onset of analgesia of a paracetamol tablet containing sodium bicarbonate: A double-blind, placebo-controlled study in adult patients with acute sore throat. Clin Ther 2006; 28:1273.
- Wing A, Villa-Roel C, Yeh B, et al. Effectiveness of corticosteroid treatment in acute pharyngitis: a systematic review of the literature. Acad Emerg Med 2010; 17:476.
- Hayward G, Thompson MJ, Perera R, et al. Corticosteroids as standalone or add-on treatment for sore throat. Cochrane Database Syst Rev 2012; 10:CD008268.
- Hayward GN, Hay AD, Moore MV, et al. Effect of Oral Dexamethasone Without Immediate Antibiotics vs Placebo on Acute Sore Throat in Adults: A Randomized Clinical Trial. JAMA 2017; 317:1535.
- Limb M, Connor A, Pickford M, et al. Scintigraphy can be used to compare delivery of sore throat formulations. Int J Clin Pract 2009; 63:606.
- Watt EE, Betts BA, Kotey FO, et al. Menthol shares general anesthetic activity and sites of action on the GABA(A) receptor with the intravenous agent, propofol. Eur J Pharmacol 2008; 590:120.
- Busch R, Graubaum HJ, Grünwald J, Schmidt M. Double-blind comparison of two types of benzocaine lozenges for the treatment of acute pharyngitis. Arzneimittelforschung 2010; 60:245.
- Kagan G, Huddlestone L, Wolstencroft P. Two lozenges containing benzocaine assessed in the relief of sore throat. J Int Med Res 1982; 10:443.
- Chrubasik S, Beime B, Magora F. Efficacy of a benzocaine lozenge in the treatment of uncomplicated sore throat. Eur Arch Otorhinolaryngol 2012; 269:571.
- Wonnemann M, Helm I, Stauss-Grabo M, et al. Lidocaine 8 mg sore throat lozenges in the treatment of acute pharyngitis. A new therapeutic option investigated in comparison to placebo treatment. Arzneimittelforschung 2007; 57:689.
- Schutz A, Gund HJ, Pschorn U, et al. Local anaesthetic properties of ambroxol hydrochloride lozenges in view of sore throat. Clinical proof of concept. Arzneimittelforschung 2002; 52:194.
- Fischer J, Pschorn U, Vix JM, et al. Efficacy and tolerability of ambroxol hydrochloride lozenges in sore throat. Randomised, double-blind, placebo-controlled trials regarding the local anaesthetic properties. Arzneimittelforschung 2002; 52:256.
- de Mey C, Peil H, Kölsch S, et al. Efficacy and safety of ambroxol lozenges in the treatment of acute uncomplicated sore throat. EBM-based clinical documentation. Arzneimittelforschung 2008; 58:557.
- McNally D, Simpson M, Morris C, et al. Rapid relief of acute sore throat with AMC/DCBA throat lozenges: randomised controlled trial. Int J Clin Pract 2010; 64:194.
- Wade AG, Morris C, Shephard A, et al. A multicentre, randomised, double-blind, single-dose study assessing the efficacy of AMC/DCBA Warm lozenge or AMC/DCBA Cool lozenge in the relief of acute sore throat. BMC Fam Pract 2011; 12:6.
- Watson N, Nimmo WS, Christian J, et al. Relief of sore throat with the anti-inflammatory throat lozenge flurbiprofen 8.75 mg: a randomised, double-blind, placebo-controlled study of efficacy and safety. Int J Clin Pract 2000; 54:490.
- Blagden M, Christian J, Miller K, Charlesworth A. Multidose flurbiprofen 8.75 mg lozenges in the treatment of sore throat: a randomised, double-blind, placebo-controlled study in UK general practice centres. Int J Clin Pract 2002; 56:95.
- Schachtel B, Aspley S, Shephard A, et al. Onset of action of a lozenge containing flurbiprofen 8.75 mg: a randomized, double-blind, placebo-controlled trial with a new method for measuring onset of analgesic activity. Pain 2014; 155:422.
- Shephard A, Smith G, Aspley S, Schachtel BP. Randomised, double-blind, placebo-controlled studies on flurbiprofen 8.75 mg lozenges in patients with/without group A or C streptococcal throat infection, with an assessment of clinicians' prediction of 'strep throat'. Int J Clin Pract 2015; 69:59.
- Aspley S, Shephard A, Schachtel E, et al. Efficacy of flurbiprofen 8.75 mg lozenge in patients with a swollen and inflamed sore throat. Curr Med Res Opin 2016; 32:1529.
- Buchholz V, Leuwer M, Ahrens J, et al. Topical antiseptics for the treatment of sore throat block voltage-gated neuronal sodium channels in a local anaesthetic-like manner. Naunyn Schmiedebergs Arch Pharmacol 2009; 380:161.
- Cingi C, Songu M, Ural A, et al. Effects of chlorhexidine/benzydamine mouth spray on pain and quality of life in acute viral pharyngitis: a prospective, randomized, double-blind, placebo-controlled, multicenter study. Ear Nose Throat J 2010; 89:546.
- Cingi C, Songu M, Ural A, et al. Effect of chlorhexidine gluconate and benzydamine hydrochloride mouth spray on clinical signs and quality of life of patients with streptococcal tonsillopharyngitis: multicentre, prospective, randomised, double-blinded, placebo-controlled study. J Laryngol Otol 2011; 125:620.
- Schapowal A, Berger D, Klein P, Suter A. Echinacea/sage or chlorhexidine/lidocaine for treating acute sore throats: a randomized double-blind trial. Eur J Med Res 2009; 14:406.
- Brinckmann J, Sigwart H, van Houten Taylor L. Safety and efficacy of a traditional herbal medicine (Throat Coat) in symptomatic temporary relief of pain in patients with acute pharyngitis: a multicenter, prospective, randomized, double-blinded, placebo-controlled study. J Altern Complement Med 2003; 9:285.
- Moss DA, Crawford P. Ear Acupuncture for Acute Sore Throat: A Randomized Controlled Trial. J Am Board Fam Med 2015; 28:697.
- Fleckenstein J, Lill C, Lüdtke R, et al. A single point acupuncture treatment at large intestine meridian: a randomized controlled trial in acute tonsillitis and pharyngitis. Clin J Pain 2009; 25:624.
- Huang Y, Wu T, Zeng L, Li S. Chinese medicinal herbs for sore throat. Cochrane Database Syst Rev 2012; :CD004877.
- GENERAL CONCEPTS
- Approach to symptom control
- Avoid antibiotic overprescribing
- SYSTEMIC ORAL THERAPIES
- Choosing an oral analgesic
- - NSAID efficacy
- - Aspirin efficacy
- - Acetaminophen efficacy
- Limited role of glucocorticoids
- THERAPIES APPLIED TOPICALLY TO THE THROAT
- Throat sprays
- Fluids, herbs, and foods for sore throat relief
- HELPFUL ENVIRONMENTAL APPROACHES
- THERAPIES OF UNCERTAIN BENEFIT
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS