Acute pharyngitis is caused by inflammation of the inner lining of the throat, resulting in a sore throat. A sore throat is a sensation of discomfort, irritation, or other symptoms in the throat, such as pain when swallowing, a change in voice, or fever.

Virus or Bacteria, How it is important?

The causes of acute pharyngitis can be broadly divided into two main categories: infection, which is usually caused by viruses, and infection by the Group A streptococcus (GAS) bacterium, which is a spherical bacterium that arranges itself in chains.

The difference between the two causes of infection lies in the symptoms and treatment. In many cases, patients with a sore throat may resort to taking antibiotics, or as they are commonly known, "anti-inflammatory drugs," which may not actually help treat the condition but may have the adverse effect of causing antibiotic resistance.

Differentiating Acute Pharyngitis

The diagnosis and treatment of acute pharyngitis follows the Centor and Mclsaac criteria, which include the following:

Centor Criteria

• Fever (≥38.3°C)
• Tonsillar exudate
• Tender lymphadenopathy (enlarged, tender neck nodes)
• No cough

Mclsaac Criteria

• Fever (≥38°C)
• Tonsillar exudate
• Absence of cough
• Painful anterior cervical adenopathy

Treatment

Treatment for Viral Pharyngitis

For patients with a score of less than 2 points, it is more likely that the patient has a viral cause, so symptomatic treatment is used with topical medications such as lozenges, throat sprays, NSAIDs, corticosteroids, and herbal remedies such as Andrographis paniculata. In cases not caused by infection, treatment should be considered according to the specific condition.

Treatment for Group A Streptococcal (GAS) Infection

For patients with a score of 2-4 points according to the Centor and Mclsaac criteria, antibiotics are used to treat Group A streptococcal (GAS) infection. Antibiotics for treating Group A streptococcus (GAS) include penicillin (including ampicillin and amoxicillin), cephalosporins, macrolides (including Roxithromycin and Azithromycin), or clindamycin.

The duration and dosage of antibiotics generally require 10 days to eliminate Group A streptococcus (GAS) and prevent recurrence, even if the patient's symptoms resolve within 2 days. Cefpodoxime, cefdinir, or Azithromycin will be taken for 5 days.

Importance of Differentiating Viral and Bacterial Pharyngitis

Proper diagnosis of the cause of pharyngitis, whether viral or bacterial, is crucial for appropriate medication use. Viral pharyngitis does not require antibiotics and is treated symptomatically only, while bacterial pharyngitis requires antibiotics. Patients should therefore receive an appropriate diagnosis to prevent the progression of symptoms without treatment or to prevent unnecessary antibiotic use.

In addition to using antibiotics rationally and completing the prescribed course of treatment, patients can help reduce the problem of antibiotic resistance, a major cause of treatment failure for bacterial infections today. Therefore, both physicians and patients should emphasize the importance of appropriate and responsible medication use for the benefit of society as a whole.

Reference

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3. 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.

4. ESCMID Sore Throat Guideline Group, Pelucchi C, Grigoryan L, et al. Guideline for the management of acute sore throat. Clin Microbiol Infect 2012; 18 Suppl 1:1.

5. Shulman ST, Bisno AL, Clegg HW, et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2 0 1 2 update by the Infectious Diseases Society of America. Clin Infect Dis 2012; 55:1279.