Pharyngitis: Diagnosis and Management

Children and young adults visit physicians more often for sore throats than any other problem or symptom. Pharyngitis or tonsillitis is diagnosed 12 million times a year in persons less than 21 years of age.1 An additional 12 to 60 million cases are never brought to medical attention. Up to a decade ago there seemed to be agreement on what one should do for this common problem: treat only those patients identified by throat cultures as having group A β-hemolytic streptococcal (GABHS) pharyngitis. As the epidemiology of infectious pharyngitis and its sequelae has changed, this strategy has come under increasing scrutiny. It is now argued that it is not always possible to implement this time-honored policy and it may not even be cost effective. Today it is estimated that nearly 70% of patients with pharyngitis do not have their throat cultured whereas 25% receive an injection at the time of their initial visit. The considerable variation in recommendations that is encountered when reading the literature stems from the frailties of existing data and value judgments. This paper shall review briefly the current status of our knowledge about pharyngitis and the implications of choosing from alternative diagnostic and management approaches. Although a patient complaining of a sore throat may have an irritation in the trachea and epiglottis, an inflamed pharynx is most often responsible.