Management
- Depends on the cause!
Pain Relief
- Ibuprofen 400 mg three times daily is recommended for relief of fever, headache and throat pain in adults with sore throat.
Alternative Pain Relief
- Who are intolerant to ibuprofen, paracetamol 1 g four times daily when required is recommended for symptom relief.
Pain Relief in Children
- In children, an adequate dose of paracetamol should be used as first line treatment for pain relief.
- Ibuprofen can be used as an alternative to paracetamol in children.
Viral Causes
- Between 50 to 80% of infections.
- Usually lasts five to seven days and doesn’t require medical treatment.
- Viral causes of sore throat include influenza and infectious mononucleosis.
Bacterial Causes
- Use of antibiotics in sore throat in which GABHS has been detected.
- Oral penicillin V given 6-hourly for 10 days is widely regarded as the gold standard treatment.
Antibiotics Usage
- Antibiotics should not be used to secure symptomatic relief in sore throat.
Antibiotics in Recurrent Sore Throat
The reasons may include:
- Inappropriate antibiotic therapy
- Inadequate dose
- Or duration of previous therapy
- Antibiotic prophylaxis for recurrent sore throat is not recommended.
Evidence on Sore Throats
- There is no evidence that bacterial sore throats are more severe than viral ones or that the duration of the illness is significantly different in either case.
Information Leaflet
- Patients should manage sore throat at home.
- Advise patients to contact their GP if they have the following symptoms:
- Difficulty in breathing
- Difficulty in swallowing or opening their mouth
- Persistent high temperature
- Particularly severe illness, especially with symptoms mainly on one side of the throat
- Sore throat which has been worsening for several days.
Emergency Hospital Admission
- Sore throat with stridor
- Progressive difficulty with swallowing
- Increasing pain, or severe systemic symptoms.
- Peritonsillar cellulitis or abscess (quinsy)
- Glandular fever (infectious mononucleosis)
- Severe uncomplicated tonsillitis associated with dysphagia and dehydration.
- If breathing difficulty is present, urgent referral to hospital is mandatory and attempts to examine the throat should be avoided. Suspect
- (Acute epiglottitis)
Tonsillectomy
- Tonsillectomy is a surgical procedure in which each tonsil is removed from a recess in the side of the pharynx called the tonsillar fossa.
Tonsillectomy Benefits
-
Tonsillectomy can prevent recurrent acute attacks of tonsillitis but not recurrent sore throats due to other causes.
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Before considering tonsillectomy the diagnosis of recurrent tonsillitis should be confirmed.
Tonsillectomy Recommendations
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Watchful waiting is more appropriate than tonsillectomy for children with mild sore throats.
-
Tonsillectomy is recommended for recurrent severe sore throat in adults.
Indications for Tonsillectomy
- Sore throats are due to acute tonsillitis.
- The episodes of sore throat are disabling
and prevent normal functioning. - Seven or more well documented, clinically significant, adequately treated sore throats in the preceding year.
- Five or more such episodes in each of the preceding two years.
- Three or more such episodes in each of the preceding three years.
- These indications are in both children and adults.
Complications of Tonsillectomy
- Tonsillectomy requires a short admission to hospital and a general anesthesia.
- It is occasionally complicated by bleeding.
- Return to usual activities takes on average two weeks, with a corresponding loss of time from education or work.
Health Promotion
- Educate the patient about the disease and provide an information leaflet to help manage sore throat at home.
- Advise the patient to lead a healthy lifestyle.
- Promote immunization in children.
Additional Health Promotion
- Advise the patient to lose weight, control lipid levels and blood sugar and pressure if needed.
- Promote screening for breast cancer in females.
- Advise smoker patients to quit smoking and educate about complications of smoking.