Acute pharyngitis, commonly referred to as a “sore throat,” is a sudden painful inflammation of the pharynx caused mostly by viral infections, with bacterial infections accounting for the remainder of cases. When group A streptococci cause acute pharyngitis, the condition is known as strep throat. The inflammatory response results in pain, fever, vasodilation, edema, and tissue damage, manifested by redness and swelling in the tonsillar pillars, uvula, and soft palate. Uncomplicated viral infections usually subside within 3 to 10 days. Pharyngitis caused by more virulent bacteria is a more severe illness because of dangerous complications (e.g., sinusitis, otitis media, peritonsillar abscess, mastoiditis, and cervical adenitis). In rare cases, the infection may lead to bacteremia, pneumonia, meningitis, rheumatic fever, and nephritis.

• Fiery-red pharyngeal membrane and tonsils
• Lymphoid follicles swollen and freckled with white-purple exudate
• Cervical lymph nodes enlarged and tender
• Fever, malaise, and sore throat
• Hoarseness

• Swab specimens obtained from posterior pharynx and tonsils (tongue not included)
• Rapid antigen detection test (RADT) for streptococcus used with professional clinical evaluation
• Backup culture of negative RADT

Viral pharyngitis is treated with supportive measures, whereas antibiotic agents are used to treat pharyngitis caused by bacteria: penicillin (5 days) for group A streptococci and cephalosporins and macrolides (from 3 to 10 days) for patients with penicillin allergies or erythromycin resistance. In addition, a liquid or soft diet is recommended during the acute stage. In severe instances, IV fluids are given if the patient cannot swallow. If the patient can swallow, he or she is encouraged to drink at least 2 to 3 L of fluid daily.

Analgesic medications (e.g., aspirin or acetaminophen [Tylenol]) can be given at 4- to 6-hour intervals; if required, acetaminophen with codeine can be taken three or four times daily.

• Encourage bed rest during febrile stage of illness; encourage frequent rest periods once patient is up and about.
• Instruct patient about signs and symptoms that warrant prompt contact with the primary provider including dyspnea, drooling, inability to swallow, and inability to fully open the mouth.
• Instruct patient about secretion precautions (e.g., disposing of used tissues properly) to prevent spread of infection and to replace his or her toothbrush.
• Examine patient's skin once or twice daily for possible rash because acute pharyngitis may precede some other communicable disease (e.g., rubella).
• Administer warm saline gargles or irrigations (105°F to 110°F [40.6°C to 43.3°C]) to ease pain. Also instruct patient regarding purpose and technique for warm gargles (as warm as patient can tolerate) to promote maximum effectiveness.
• Apply an ice collar for symptomatic relief.
• Perform mouth care to prevent fissures of lips and inflammation in the mouth.
• Permit gradual resumption of activity.
• Advise patient of importance of taking the full course of antibiotic therapy.
• Inform patient and family of symptoms to watch for, signs that may indicate development of complications, including nephritis and rheumatic fever.

For more information, see Chapter 22 in Hinkle, J. L., & Cheever, K. H. (2018). Brunner and Suddarth's textbook of medical-surgical nursing (14th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.