Pharyngitis is an inflammation of the throat, caused by a virus or, less frequently, bacteria. Both types of infection lead to the same symptoms, which include a sore throat, pain when swallowing, and occasionally breathing difficulty. Among viral infections, pharyngitis can occur in association with the common cold, influenza, and infectious mononucleosis. Bacterial infections responsible for the condition include beta-streptococcus, Mycoplasma pneumoniae, and those involved in sexually transmitted diseases such as gonorrhea. About one in five patients with a streptococcal infection have pharyngitis. Symptoms differ little between viral and bacterial pharyngitis, although they may be more marked in the bacterial form. Differentiation between the two requires a throat culture. Chronic pharyngitis can result from continual exposure to infection or irritants. Many cases of acute viral pharyngitis subside without any treatment beyond rest. Bacterial forms generally require antibiotics, once the bacterium has been identified. In rare cases, untreated bacterial pharyngitis can lead to rheumatic fever, glomerulonephritis, otitis media, mastoiditis, pneumonia, or meningitis.

Acute pharyngitis stems from a viral infection, such as a common cold, or a bacterial infection, such as Group A beta-hemolytic streptococcus. The viral form often accompanies such disorders as the common cold, influenza, and infectious mononucleosis. Continuing infection of the sinuses, lungs, or mouth can lead to chronic pharyngitis. So can constant irritation of the pharynx that results from smoking, breathing heavily polluted air, or consuming too much alcohol over a long duration.

• Presence of an upper respiratory viral infection
• Bacteria such as beta-hemolytic streptococcus, Staphylococcus aureus, Candida albicans, Mycoplasma pneumoniae, or Chlamydia pneumoniae
• Sexually transmitted diseases, such as gonorrhea
• Continuing infection of the sinuses, lungs, or mouth
• Long-term tobacco smoking
• Long exposure to throat irritants (for example, in the workplace)
• Overuse of alcohol
• Fatigue

• Sore throat
• Pain when swallowing
• In rare cases, difficulty breathing
• Inflammation of the pharyngeal mucous membrane
• A whitish membrane or exudate of pus covering the pharyngeal mucous membrane
• Fever, headache, chills
• Enlarged lymph nodes in the neck
• Enlarged tonsils, tonsillar exudates

• Infectious mononucleosis
• Adenovirus infection
• Respiratory infection
• Polio
• Scarlet fever
• Leukopenia
• Lymphoma

Patients generally exhibit fever. Lack of fever to mild fever suggests a viral infection, while mild to moderate fever indicates bacterial pharyngitis. Examination of the throat reveals mild to severe inflammation and redness, often accompanied by a whitish membrane. A discharge of pus suggests bacterial rather than viral infection. Normal-sized or slightly enlarged lymph nodes suggest viral infection, while slightly to moderately enlarged lymph nodes increase the likelihood of a bacterial cause. In children, lymph nodes can become very enlarged with both viral and bacterial infection.

An elevated white blood count typifies both viral and bacterial pharyngitis. A throat culture proves negative in the case of the viral form, and positive for streptococcus or other bacteria in the case of bacterial infection.

Identifiable on culture.

• Ask patient to describe symptoms completely.
• Evaluate the throat by examination, seeking extent of inflammation and presence of a whitish membrane and pus.
• Check for enlarged lymph nodes in the patient's neck.
• Screen for gonococcal infection.

Once strong suspicion or positive confirmation that a bacterial infection has caused the pharyngitis, prescribe appropriate antibiotics. Pharyngitis that stems from a viral cause has no specific treatment beyond bed rest and simple forms of self-treatment, such as gargling and aspirin. Advise the patient to get plenty of rest.

Penicillin VK 250 mg tid, taken orally for 6 to 10 days, remains the drugof choice against Group A streptococcal pharyngitis, primarily to prevent rheumatic fever. As an alternative, intravenous penicillin G benzathine, or a first-generation cephalosporin. For patients allergic to penicillin, erythromycin 300 to 400 mg tid makes a suitable substitute.

Suggest over-the-counter analgesics such as aspirin or an aspirin substitute to relieve the pain of the sore throat. Take caution in prescribing aspirin for patients under 18. Patients can relieve discomfort with throat lozenges and by gargling with ½ tsp. salt in a glass of warm water several times daily. A soft or liquid diet including warm broths also helps to avoid irritating the throat.

Established strep infection should be treated with antibiotics. Alternative treatments can be effective in cases of acute, chronic, or recurrent pharyngitis. Begin with nutritional support at the first sign of a sore throat. Use the tincture and/or the tea throughout the course of infection. For mild or non-infectious pharyngitis, licorice ( Glycyrrhiza glabra) or slippery elm (Ulmus fulva) in lozenges or teas to soothe irritation may be all that is needed.

• Zinc (30 mg/day or lozenges) boosts the immune system and relieves soreness.
• Vitamin C (1,000 mg tid to qid) is needed, as bowel tolerates, for proper immune function and to strengthen mucous membranes.
• Beta-carotene (50,000 to 100,000 IU/day) restores integrity of mucous membranes and supports immunity.

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, it is important to ascertain a diagnosis before pursuing treatment. Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups/day. Tinctures may be used singly or in combination as noted. Note: Lozenges (as commercially available) should be used as directed.

• Slippery elm: Soothes irritated tissues and promotes healing. Use as lozenge or tea.
• Licorice: Antiviral properties and soothing to the throat. Use as lozenge or tea. Licorice is contraindicated in hypertension.
• Garlic/Ginger tea (Allium sativum/Zingiber officinale): Antimicrobial and warming herbs. Use two cloves of garlic and two to three slices of fresh ginger root. Simmer in one cup of water for 10 minutes. Drink warm. May add lemon and honey for flavor.
• Tincture of two parts coneflower (Echinacea purpurea), two parts goldenseal (Hydrastis canadensis), and one part propolis should be taken every three to four hours. Place 30 drops in ¼ cup water. Gargle and swallow.

An experienced homeopath should assess individual constitutional types and severity of disease to select the correct remedy and potency. For acute prescribing use 3 to 5 pellets of a 12X to 30C remedy every one to four hours until acute symptoms resolve.

• Apis for red, swollen throat with burning pains. Patient is thirstless and feels better with cold drinks.
• Belladonna for bright red throat and tongue that feels worse on the right side. Patient is thirsty.
• Lycopodium for dryness of throat; pain begins on right side and goes to left. Pain is relieved with hot drinks.

Chiropractic treatment may be a helpful adjunct, especially in children.

Acupuncture may be helpful in improving immune function.

Patients with chronic pharyngitis may respond to therapeutic massage and other mind-body therapies that reduce the effects of stress and increase the overall sense of well-being.

Avoid contact with infected persons.

• Rheumatic fever
• Systemic infection
• Otitis media
• Septicemia
• Rhinitis
• Sinusitis

Acute pharyngitis usually remits within a week to ten days. Ensure that patients prescribed antibiotics complete their course of treatment. Patients with chronic pharyngitis caused by irritants should stop smoking or drinking alcohol, and avoid exposure to heavily polluted air.

Use caution with antibiotic therapy. Goldenseal is contraindicated in pregnancy.

Berkow R, ed. Merck Manual. 16th ed. Rahway, NJ: Merck Research Laboratories; 1992.

Larson DE, ed. Mayo Clinic Family Health Book. 2nd ed. New York, NY: William Morrow and Company; 1996.

Lewis WH, Elvin-Lewis MPF. Medical Botany/Plants Affecting Man's Health. New York, NY: John Wiley & Sons; 1977.

Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany, Calif: Hahnemann Clinic Publishing; 1993:5, 28.