Acute pharyngitis caused by viruses does not require and should not be treated with antibiotics, as they have no effect. However, if the cause of pharyngitis is bacterial, antibiotics are necessary and should be taken for 5-7 days.
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Location of Pharyngitis |
Pharyngitis has many causes, with the majority being viral (80%) such as adenovirus, rhinovirus, respiratory syncytial virus, influenza, and measles. The remaining cases are caused by bacteria such as streptococcus, staphylococcus, pneumococcus, and Haemophilus influenzae. The most dangerous is Group A beta-hemolytic streptococcus, as it can lead to complications like rheumatic fever, arthritis, and nephritis.
Risk factors for pharyngitis include weather changes, extreme cold, excessive humidity, dust, tobacco smoke, alcohol, and chemicals.
Acute Pharyngitis
Red Pharyngitis: Symptoms include fever, fatigue, often sudden high fever of 39-40 degrees Celsius, body aches, poor appetite, and irritability in children. If caused by a bacterial infection, the signs of infection are quite evident, such as dry lips, coated tongue, rapid pulse, and a tired, haggard appearance.
Patients experience sore throat and pain when drinking or swallowing saliva, but swallowing solid foods is less painful; however, they still find it difficult to swallow and feel a burning sensation. Coughing is a common secondary symptom, which can be paroxysmal, productive with mucus, and initially white before turning thick and yellow with a foul odor, along with changes in voice quality. Specifically, the voice may be unclear, slightly hoarse, or even completely hoarse. The entire throat mucosa appears bright red, with swollen, red tonsils. Lymph nodes at the angle of the jaw may be swollen and painful.
White Pharyngitis: This is primarily seen in diphtheria and Vincent’s angina. In diphtheria, the patient may not have a high fever but exhibits significant signs of toxicity such as pallor, fatigue, and reduced urination; they experience pain and a feeling of obstruction when swallowing, and may cough up some mucus, with changes in voice. The throat, especially the area above the tonsils, may have a firmly adhered white pseudomembrane.
Vincent’s angina is often seen in older adults, where the pseudomembrane is usually thin and easily comes off, revealing a shallow ulcer underneath.
Additionally, white pharyngitis often causes swollen lymph nodes in the neck area.
Chronic Pharyngitis
This is a very common condition across all ages, primarily caused by factors such as alcohol, tobacco, toxic fumes, smoke, and dust. Clinical symptoms are usually mild, not affecting the whole body, and there is no fever; the person may just feel fatigued. The most important signs are a burning sensation in the throat, difficulty swallowing, and particularly persistent or continuous coughing, which may be dry and produce little mucus, causing significant discomfort and frequent expectoration throughout the day.
Pharyngitis can lead to complications such as abscesses, peritonsillar cellulitis (in children, this can manifest as a retro-pharyngeal abscess); it can also lead to rhinitis, sinusitis (especially in children, with otitis media being a common complication that is often undetected).
Moreover, pharyngitis can extend to the larynx, causing laryngitis or laryngotracheobronchitis, bronchitis, or pneumonia. Distant complications may include glomerulonephritis, arthritis, and pericarditis…
Regarding treatment, if acute pharyngitis is caused by a virus, antibiotics are not necessary; only antipyretics such as effervescent tablets, paracetamol, and aspirin (only when the temperature exceeds 38 degrees Celsius) are required. Cough suppressants such as Phenergan syrup, expectorants, and Theralen can also be used.
For bacterial pharyngitis, antibiotics must be administered based on a sensitivity test, typically for 5-7 days. Particularly for diphtheria, patients should be referred to infectious disease departments and should not be treated at home. In addition to appropriate antibiotic therapy, detoxifying agents must be used to prevent cardiac and renal complications. Local treatments may include throat sprays using antibiotics and anti-inflammatories. Additionally, throat painting with agents such as borax glycerin may be helpful.
In cases of chronic pharyngitis, rinsing the throat with alkaline solutions to maintain throat pH is recommended, and interventions such as cauterization of tonsillar tissue with silver nitrate (AgNO3), chromic acid, electrocautery, or CO2 laser may be considered. However, caution is needed during cauterization to ensure only the tissue is treated without damaging the throat mucosa.
