1. Introduction
- Definition: A sore throat, or pharyngitis, refers to pain, discomfort, or scratchiness in the throat, often aggravated by swallowing. It is typically caused by infections or irritation of the pharynx.
- Epidemiology: Sore throat accounts for approximately 12% of outpatient visits globally, with the highest incidence in children and young adults.
- Significance: While most cases are self-limiting, bacterial causes like streptococcal pharyngitis may require prompt treatment to prevent complications.
2. Causes and Risk Factors
- Causes:
- Infectious:
- Viral (most common): Adenovirus, rhinovirus, influenza, Epstein-Barr virus (EBV).
- Bacterial: Group A Streptococcus pyogenes (strep throat), Mycoplasma pneumoniae.
- Fungal: Candida species (in immunocompromised patients).
- Non-infectious:
- Allergies, dry air, acid reflux (laryngopharyngeal reflux).
- Irritants like smoking or pollutants.
- Infectious:
- Risk Factors:
- Close contact with infected individuals (e.g., in schools or crowded settings).
- Seasonal factors (higher in winter or flu season).
- Weakened immune system.
3. Pathophysiology
- The causative agent triggers inflammation of the pharyngeal mucosa, leading to pain and swelling. In bacterial infections, toxins from pathogens like Streptococcus pyogenes exacerbate the inflammatory response, causing fever and lymphadenopathy.
4. Symptoms and Features
- Common Symptoms:
- Pain or scratchiness in the throat.
- Difficulty swallowing (odynophagia).
- Red and swollen throat or tonsils.
- Condition-Specific Features:
- Viral: Accompanied by cough, rhinorrhoea, and hoarseness.
- Bacterial: Fever >38°C, tender cervical lymph nodes, absence of cough, and tonsillar exudates.
- Allergic: Itchy throat, watery eyes, and sneezing.
5. Complications
- Bacterial Pharyngitis:
- Rheumatic fever or rheumatic heart disease.
- Post-streptococcal glomerulonephritis.
- Viral Pharyngitis:
- Dehydration due to difficulty swallowing.
- Other: Peritonsillar abscess or airway obstruction (rare).
6. Diagnosis
- Clinical Features: History and physical examination to differentiate viral vs bacterial causes.
- Diagnostic Tests:
- Rapid antigen detection test (RADT) for Group A Streptococcus.
- Throat culture for confirmation in suspected bacterial cases.
- Blood tests (e.g., monospot test) for Epstein-Barr virus if infectious mononucleosis is suspected.
7. Management Overview
- Goals: Relieve symptoms, eradicate infection (if bacterial), and prevent complications.
- Approach: Supportive care for viral causes, antibiotics for confirmed bacterial infections, and avoidance of irritants in non-infectious causes.
8. Treatment Options with Cost (USD)
- Supportive Care:
- Lozenges or sprays (e.g., benzocaine): ~$5–$15 per pack.
- Paracetamol or ibuprofen for pain relief: ~$5–$10 per pack.
- Saltwater gargles: Minimal cost.
- Antibiotics (if bacterial):
- Penicillin or amoxicillin: ~$10–$20 per course.
- Alternative (for penicillin-allergic patients): Azithromycin: ~$15–$30 per course.
9. Advanced Treatment Options with Cost (USD)
- Severe Cases or Complications:
- Hospitalisation for abscess drainage: ~$5,000–$10,000.
- Corticosteroids for severe swelling: ~$10–$30 per course.
10. Pharmacological Treatment
- First-line: Penicillin or amoxicillin for streptococcal pharyngitis.
- Adjunctive: NSAIDs or lozenges for symptom relief.
- Refractory Cases: Clindamycin or cefuroxime for resistant infections.
11. Medication Tables
Table 1: Doses and Side Effects
Drug | Indication | Dose | Common Side Effects |
---|---|---|---|
Penicillin V | Streptococcal pharyngitis | 250 mg 2–3 times daily for 10 days | GI upset, rash |
Amoxicillin | Streptococcal pharyngitis | 500 mg twice daily for 10 days | Diarrhoea, rash |
Azithromycin | Penicillin allergy | 500 mg on day 1, then 250 mg daily for 4 days | GI upset, headache |
Ibuprofen | Pain relief | 200–400 mg every 6–8 hours | Stomach upset, dizziness |
Benzocaine lozenges | Symptom relief | As needed | Numbness, throat irritation |
Table 2: Brand Names and Approximate Costs (USD)
Drug | Brand Names | Approx. Cost |
---|---|---|
Penicillin V | Pen VK | $10–$15 per course |
Amoxicillin | Amoxil | $10–$20 per course |
Azithromycin | Zithromax | $15–$30 per course |
Ibuprofen | Advil, Motrin | $5–$10 per pack |
Benzocaine lozenges | Cepacol, Chloraseptic | $5–$15 per pack |
12. Lifestyle Interventions
- Rest and stay hydrated to support recovery.
- Avoid irritants like smoking and strong odours.
- Use a humidifier to moisten the air and ease throat discomfort.
- Consume soothing liquids such as warm tea with honey or broths.
13. Monitoring Parameters
- Symptom resolution within 7–10 days for viral causes and 24–48 hours for bacterial cases on antibiotics.
- Monitor for complications, especially in bacterial infections (e.g., rheumatic fever).
- Assess for recurrent sore throat, which may indicate underlying conditions like tonsillar hypertrophy.
14. Patient Counseling Points
- Explain that most sore throats are viral and self-limiting, requiring supportive care only.
- Stress the importance of completing antibiotic courses for bacterial infections to prevent complications.
- Avoid overuse of lozenges containing anaesthetics as they may cause irritation.
- Seek immediate medical attention if symptoms worsen or include difficulty breathing, drooling, or severe swelling.
15. Special Populations
- In Children: Consider weight-based dosing for antibiotics; assess for signs of streptococcal pharyngitis (fever, swollen lymph nodes).
- In Pregnancy: Penicillin or amoxicillin are safe; avoid NSAIDs.
- In Immunocompromised Individuals: Higher risk of severe or atypical infections; ensure early diagnosis and treatment.
16. Prevention
- Practice good hand hygiene to reduce the spread of infectious agents.
- Avoid close contact with individuals who have respiratory infections.
- Manage underlying conditions like allergies or acid reflux to prevent recurrent sore throat.
- Stay up to date on vaccinations (e.g., flu vaccine) to prevent viral infections.
17. FAQs
- What causes a sore throat?
Answer: Most commonly viral infections, but bacterial, fungal, or irritants can also cause it. - How can I tell if my sore throat is viral or bacterial?
Answer: Bacterial sore throat often includes fever, absence of cough, and white patches on tonsils. - Do I need antibiotics for a sore throat?
Answer: Only if it is confirmed as bacterial, such as strep throat. - How long does a sore throat last?
Answer: Viral sore throats resolve in 5–7 days, while bacterial ones improve within 24–48 hours on antibiotics. - What are home remedies for a sore throat?
Answer: Saltwater gargles, warm tea with honey, and staying hydrated. - When should I see a doctor for a sore throat?
Answer: If it lasts >10 days, worsens, or includes difficulty swallowing or breathing. - Is a sore throat contagious?
Answer: Yes, if caused by an infectious agent like a virus or bacteria. - Can allergies cause a sore throat?
Answer: Yes, due to postnasal drip and throat irritation. - What is strep throat?
Answer: A bacterial infection caused by Group A Streptococcus. - Can children get a sore throat frequently?
Answer: Yes, especially if exposed to infections in schools or daycares. - Are throat sprays effective?
Answer: Yes, they provide temporary relief by numbing the throat. - What foods help with a sore throat?
Answer: Warm liquids, soft foods, and broths are soothing. - Can a humidifier help?
Answer: Yes, it moistens dry air and soothes the throat. - Is it safe to exercise with a sore throat?
Answer: Mild exercise is fine if symptoms are above the neck and no fever is present. - How can I prevent sore throats in children?
Answer: Good hygiene, avoiding sick contacts, and managing allergies.