Acute Viral pharyngitis

Description

Pharyngitis is the term used to describe inflammation of the pharynx (back of the throat) and may include the uvula (the small finger of tissue that hangs down at the back of the throat) and the tonsils (oval patches of tissue located on each side of the uvula). Inflammation of the tonsils is often accompanied by inflammation of the adenoids which are situated above the uvula. Inflammation of the tonsils and adenoids results in red swollen painful patches of tissue which may interfere with breathing or swallowing and sense of smell. The impaired breathing is caused by the swollen adenoids partially blocking the nasal passages which can result in snoring and the typical stuffy nose voice.

Pharyngiti, more commonly known as sore throat

Most cases of pharyngitis are caused by viruses,  particularly adenoviruses, enteroviruses or Epstein Barr virus. Infection with adenovirus often causes an accompanying conjunctivitis.
Bactria may also infect the tonsils or adenoids, particularly Streptococcus pyogenes – hence the expression strep throat. Neisseria gonorrhoeae can cause pharyngitis in sexually active individuals.
In some patients, infection may progress to produce a peritonsillar abscess also known as Quinsy. Some individuals are particularly susceptible to tonsillar infections and suffer repeated bouts of pharyngitis.
Infection with Streptococcus pyogenes may result in the subsequent development of rheumatic heart disease caused by the immune system attacking antigens on the heart valve which it mistakes for antigens on the bacteria, or glomerulonephritis caused by the deposition of antigen/antibody complexes in the kidneys.

Signs & Symptoms

Pharyngitis usually presents as sore throat, with difficult or painful swallowing, if the uvula is involved, and nasal blockage with mouth breathing if the adenoids are involved.

Treatment

Viral sore throats will normally resolve without treatment. Pain can be managed with analgesics.
Antibiotic treatment is indicated if streptococcal infection is suspected, patient has rheumatic heart disease or peritonsillar cellulitis or abscess is present.

Phenoxymethyl penicillin
Adult
500mg (O) bd for 10 days   
Child
50mg/kg/day to max 1g/day for 10 days

Roxithromycin
Adult
300mg (O) daily for 10 days           
Child
4mg/kg to max150 mg (O) bd for 10 days

In severe cases oral penicillin may be supplemented with procaine penicillin, 1-1.5 mg IM  daily for 3-5 days
Non-compliant adult patients can be treated with a single dose of benzathine penicillin – 900 mg IM
Ampicillin should not be used to avoid complicating a possible diagnosis of infectious mononucleosis.
Peritonsillar abscess which fails to respond to antibiotics, may require drainage.
Removal of tonsils (tonsillectomy) may be indicated if patient suffers repeated infections or has chronic tonsillitis

Patient Management

Maintain good fluid intake, particularly cold drinks and rest voice.