What Are the Symptoms of Pharyngitis, and Which Medications Treat It?

Pharyngitis—commonly known as a sore throat—is an inflammatory condition affecting the pharynx, the muscular tube extending from the back of the nasal cavity to the larynx and upper esophagus. It is most frequently caused by viral infections, including rhinovirus, influenza virus, adenovirus, and Epstein–Barr virus (the causative agent of infectious mononucleosis). Less commonly, bacterial pathogens—particularly *Streptococcus pyogenes* (Group A Streptococcus)—are responsible, accounting for approximately 5–10% of acute pharyngitis cases in adults and up to 30% in children.

Clinical presentation varies depending on etiology but typically includes sore throat, pain exacerbated by swallowing (odynophagia), pharyngeal erythema, and tonsillar enlargement. Additional signs may include fever, tender anterior cervical lymphadenopathy, palatal petechiae, and exudative tonsillar plaques. Viral pharyngitis often presents with concurrent symptoms such as rhinorrhea, cough, hoarseness, or conjunctivitis—features that are uncommon in streptococcal infection. In contrast, abrupt onset of severe sore throat, absence of cough, and presence of fever and tender lymphadenopathy should raise suspicion for Group A Streptococcus and warrant diagnostic testing.

Management is primarily supportive for viral cases: adequate hydration, analgesics such as acetaminophen or ibuprofen for pain and fever control, and throat lozenges or warm saline gargles for symptomatic relief. Antibiotics are not indicated for viral pharyngitis and offer no clinical benefit while contributing to antimicrobial resistance.

For confirmed or highly probable Group A Streptococcal pharyngitis—diagnosed via rapid antigen detection test (RADT) and/or throat culture—penicillin remains the first-line antibiotic. Oral penicillin V is typically prescribed for 10 days; alternatively, a single intramuscular dose of benzathine penicillin G may be used. For patients with penicillin allergy, alternatives include first-generation cephalosporins (e.g., cephalexin) in non–type I hypersensitivity cases, or clindamycin or clarithromycin when beta-lactam allergy is confirmed. Azithromycin is reserved for select cases due to rising macrolide resistance rates in some regions.

It is critical to distinguish pharyngitis from other conditions presenting with sore throat—including peritonsillar abscess, epiglottitis, or retropharyngeal abscess—which may require urgent intervention. Persistent symptoms beyond 10 days, recurrent episodes, or systemic signs such as high fever, neck stiffness, or difficulty breathing warrant prompt reevaluation and further investigation.