Pharyngitis: Drug Therapy

Therapeutic targets

  • Alleviation of symptoms
  • Avoidance of complications

Therapy recommendations

  • All patients should be offered analgesics (pain relievers; preferably acetaminophen or ibuprofen), if appropriate.
  • For decision making for antibiosis (antibiotic therapy).
    • No clinical signs of GABHS pharyngitis (= group A beta-hemolytic streptococci): 0-2 centor criteria (see score under “Physical examination“) + no contact with GAS pharyngitis → GABHS pharyngitis rather unlikely (thus no examination for GAS and no antibiotic therapy).
    • Clinical signs of GABHS pharyngitis (A streptococcal infection): 3-4 centor criteria (see score under laboratory diagnostics) + contact to GABHS pharyngitis → GABHS pharyngitis rather likely; depending on the clinic immediately or only in case of worsening penicillin for 7 days (in case of intolerance erythromycin).
  • In case of decision relevance: throat swab or rapid test.
  • See also under “Further therapy“.

Further notes

  • Dexamethasone treatment: a meta-analysis showed:
    • Probability of symptom relief at 24 hours more than doubled in patients treated with dexamethasone (10 mg, single oral dose) compared to patients treated with a placebo (sham) (relative risk [RR]: 2.2; 95% confidence interval: 1.2-4.3)
    • Pain relief occurred on average 4.8 hours earlier than in the comparison group
    • Probability of being pain-free after 48 hours was higher by a factor of 1.5 (RR: 1.5; 95% confidence interval: 1.3-1.8)
    • Strongest absolute pain relief was observed in patients with severe pain.
  • Patients taking nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids as a result of pharyngitis had a threefold increased risk of peritonsillar abscess (abscess formation/formation of a pus cavity in the loose connective tissue surrounding the palatine tonsil). Limitation: the association may be due to indication bias.

Caveat. Acetylsalicylic acid (ASA) should not be used in children under 12 years of age, otherwise a life-threatening complication – called Reye’s syndrome – may occur. This condition is associated with brain and liver damage and is life-threatening for affected children. With acetaminophen, the maximum dose must not be exceeded, otherwise liver damage may occur.

Supplements (dietary supplements; vital substances)

Suitable dietary supplements for natural defense should contain the following vital substances:

Note: The listed vital substances are not a substitute for drug therapy. Dietary supplements are intended to supplement the general diet in the particular life situation.