Sore throat

Sore throat, also known as throat pain, is pain or irritation of the throat. Sore throat is usually caused by a viral infection or a group A streptococcus (GAS) bacterial infection.[1] Other causes include pharyngitis (inflammation of the throat), tonsillitis (inflammation of the tonsils), or dehydration, which leads to the throat drying up. It can also result from trauma. The majority of sore throats are caused by a virus, for which antibiotics are not helpful.[1] A strong association between antibiotic misuse and antibiotic resistance has been shown.[2]

For other uses, see Sore throat (disambiguation).
Sore throat
Viral pharyngitis, the most common cause of a sore throat.

For sore throat caused by bacteria (GAS), treatment with antibiotics may help the person get better faster, reduce the risk that the bacterial infection does not spread, prevent retropharyngeal abscesses and quinsy, and reduce the risk of other complications such as rheumatic fever and rheumatic heart disease.[1] In most developed countries, post-streptococcal diseases have become far less common. For this reason, awareness and public health initiatives to promote minimizing the use of antibiotics for viral infections has become the focus.[1]

Approximately 35% of childhood sore throats and 5-25% of adults sore throats are caused by a bacterial infection from group A streptococcus.[1] Sore throats that are "non-group A streptococcus" are assumed to be caused by a viral infection. Sore throat is a common reason for people to visit their primary care doctors and the top reason for antibiotic prescriptions by primary care practitioners such as family doctors.[1] In the United States, about 1% of all visits to the hospital emergency department, physician office and medical clinics, and outpatient clinics are for sore throat (over 7 million visits for adults and 7 million visits for children per year).[1]

Definition

A sore throat is the pain felt anywhere in the throat.[3]

Diagnosis

The most common cause (80%) is acute viral pharyngitis, a viral infection of the throat.[3] Other causes include other bacterial infections (such as group A streptococcus or streptococcal pharyngitis), trauma, and tumors.[3] Gastroesophageal (acid) reflux disease can cause stomach acid to back up into the throat and also cause the throat to become sore.[4] In children, streptococcal pharyngitis is the cause of 35–37% of sore throats.[5][1]

The symptoms of a viral infection and a bacterial infection may be very similar. Some clinical guidelines suggest that the cause of a sore throat is confirmed prior to prescribing antibiotic therapy and only recommend antibiotics for children who are at high risk of non-suppurative complications.[6][7] A group A streptococcus infection can be diagnosed by throat culture or a rapid test. In order to perform a throat culture, a sample from the throat (obtained by swabbing) is cultured (grown) on a blood agar plate to confirm the presence of group A streptococcus.[1] Throat cultures are effective for people who have a low bacterial count (high sensitivity), however, throat cultures usually take about 48 hours to obtain the results.[1]

Clinicians often also make treatment decisions based on the person's signs and symptoms alone. In the US, approximately 2/3rd of adults and half of children with sore throat are diagnosed based on symptoms and do not have testing for the presence of GAS to confirm a bacterial infection.[1]

Rapid tests to detect GAS (bacteria) give a positive or negative result that is usually based on a colour change on a test strip that contains a throat swab (sample). Test strips detect a cell wall carbohydrate that is specific to GAS by using an immunologic reaction.[1] Rapid testing can be performed in the doctors office and usually takes 5–10 minutes for the test strip to indicate the result. Specificity for most rapid tests is approximately 95%, however sensitivity is about 85%.[1] Although the use of rapid testing has been linked with an overall reduction in antibiotic prescriptions, further research is necessary to understand other outcomes such as safety, and when the person starts to feel better.[1]

Numerous clinical scoring systems (decision tools) have also been developed to support clinical decisions. Scoring systems that have been proposed include Centor's, McIsaac's, and the feverPAIN.[1] A clinical scoring system is often used along with a rapid test.[1] The scoring systems use observed signs and symptoms in order to determine the likelihood of a bacterial infection.[1]

Management

Pain medications such as non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol (acetaminophen) help in the management of pain.[8][9] The use of corticosteroids seems to increase the likelihood of resolution and reduce the level of pain.[10][11] Antibiotics shorten the duration of pain symptoms by an average of about one day.[12] It is not known whether antibiotics are effective for preventing recurrent sore throat.[13]

There is an old wives tale that having a hot drink can help with common cold and influenza symptoms, including sore throat, but there is only limited evidence to support this idea.[14] If the sore throat is unrelated to a cold and is caused by for example tonsillitis, a cold drink may be helpful.[15]

There are also other medications like lozenges which can help people to cope with a sore throat.

Without active treatment, symptoms usually last two to seven days.[16]

Statistics

In the United States, there are about 2.4 million emergency department visits with throat-related complaints per year.[3]

References
  1. Cohen, Jérémie F.; Pauchard, Jean-Yves; Hjelm, Nils; Cohen, Robert; Chalumeau, Martin (June 2020). "Efficacy and safety of rapid tests to guide antibiotic prescriptions for sore throat". The Cochrane Database of Systematic Reviews. 6: CD012431. doi:10.1002/14651858.CD012431.pub2. ISSN 1469-493X. PMC 7271976. PMID 32497279.
  2. "Antibiotic resistance". www.who.int. Retrieved 2020-09-18.
  3. Marx, John (2010). Rosen's emergency medicine: concepts and clinical practice (7th ed.). Philadelphia, PA: Mosby/Elsevier. p. Chapter 30. ISBN 978-0-323-05472-0.
  4. "Sore Throat and Other Throat Problems-Topic Overview".
  5. Shaikh N, Leonard E, Martin JM (September 2010). "Prevalence of streptococcal pharyngitis and streptococcal carriage in children: a meta-analysis". Pediatrics. 126 (3): e557–64. doi:10.1542/peds.2009-2648. PMID 20696723. S2CID 8625679.
  6. "Group A Strep | Strep Throat | For Clinicians | GAS | CDC". www.cdc.gov. 2019-04-19. Retrieved 2020-09-18.
  7. "Clinical Practice Guidelines : Sore throat". www.rch.org.au. Retrieved 2020-09-18.
  8. Thomas M, Del Mar C, Glasziou P (October 2000). "How effective are treatments other than antibiotics for acute sore throat?". Br J Gen Pract. 50 (459): 817–20. PMC 1313826. PMID 11127175.
  9. de Cassan, Simone; Thompson, Matthew J.; Perera, Rafael; Glasziou, Paul P.; Del Mar, Chris B.; Heneghan, Carl J.; Hayward, Gail (1 May 2020). "Corticosteroids as standalone or add-on treatment for sore throat". The Cochrane Database of Systematic Reviews. 5: CD008268. doi:10.1002/14651858.CD008268.pub3. ISSN 1469-493X. PMC 7193118. PMID 32356360.
  10. Hayward, Gail; Thompson, Matthew J; Perera, Rafael; Glasziou, Paul P; Del Mar, Chris B; Heneghan, Carl J (2012-10-17). "Corticosteroids as standalone or add-on treatment for sore throat". Cochrane Database of Systematic Reviews. 10: CD008268. doi:10.1002/14651858.cd008268.pub2. PMID 23076943.
  11. Sadeghirad, Behnam; Siemieniuk, Reed A C; Brignardello-Petersen, Romina; Papola, Davide; Lytvyn, Lyubov; Vandvik, Per Olav; Merglen, Arnaud; Guyatt, Gordon H; Agoritsas, Thomas (20 September 2017). "Corticosteroids for treatment of sore throat: systematic review and meta-analysis of randomised trials". BMJ. 358: j3887. doi:10.1136/bmj.j3887. PMC 5605780. PMID 28931508.
  12. Spinks, Anneliese; Glasziou, Paul P.; Del Mar, Chris B. (2013-11-05), "Antibiotics for sore throat", The Cochrane Library, John Wiley & Sons, Ltd (11), pp. CD000023, doi:10.1002/14651858.cd000023.pub4, PMC 6457983, PMID 24190439
  13. Ng, Gareth JY; Tan, Stephanie; Vu, Anh N; Del Mar, Chris B; van Driel, Mieke L (2015-07-14). Cochrane ENT Group (ed.). "Antibiotics for preventing recurrent sore throat". Cochrane Database of Systematic Reviews (7): CD008911. doi:10.1002/14651858.CD008911.pub2. PMID 26171901.
  14. "Hot drinks ease cold and flu". National Health Service. 10 December 2008.
  15. Bathala S, Eccles R (March 2013). "A review on the mechanism of sore throat in tonsillitis". J Laryngol Otol (Review). 127 (3): 227–32. doi:10.1017/S0022215112003003. PMID 23317998.
  16. Thompson, M; Vodicka, TA; Blair, PS; Buckley, DI; Heneghan, C; Hay, AD; TARGET Programme, Team (Dec 11, 2013). "Duration of symptoms of respiratory tract infections in children: systematic review". BMJ (Clinical Research Ed.). 347: f7027. doi:10.1136/bmj.f7027. PMC 3898587. PMID 24335668.
Classification
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