Pharyngitis is a sore throat caused by inflammation of the back of the throat. It is one of the most common reasons for visits to family physicians. Your throat may be scratchy and swallowing can be painful. Usually a sore throat is the sign of another illness, such as a cold or the flu. Unless you have a bacterial infection, taking antibiotics doesn't help a sore throat. In fact, most sore throats go away in a week or less.

The symptoms that accompany a sore throat can vary, depending on what the underling illness is.

• Sneezing
• Cough
• A low fever (less than 102 °F)
• Mild headache

Sore throat with flu

• Fatigue
• Body aches
• Chills
• Fever higher than 102 °F

Sore throat with mononucleosis

• Enlarged lymph nodes in neck and armpits
• Swollen tonsils
• Headache
• Loss of appetite
• Swollen spleen
• Liver inflammation

Most sore throats are caused by viruses, although a few are due to bacterial infections. You can breathe in bacteria or a virus that are spread in the air when someone sneezes or coughs, or you can transfer the organisms to your mouth or nose by touching a surface with germs on them. Viruses that can cause sore throat include the common cold, the flu, and mononucleosis (often called "mono"). Bacteria like Group A streptococcus (commonly known as strep throat) can also cause pharyngitis.

Risk factors for pharyngitis include:

• Cold and flu seasons
• Having close contact with someone who has a sore throat or cold
• Smoking or exposure to secondhand smoke
• Frequent sinus infections
• Allergies
• Daycare attendance
• Northern European ancestry

Your doctor will check your temperature and examine your throat, sinuses, ears, nose, lungs, and neck, including feeling for swollen lymph nodes that may indicate strep throat. He or she may take a throat culture or do a rapid strep test by taking a swab from your throat. A blood test may be done to check for mononucleosis.

• Avoid kissing or sharing cups and eating utensils with anyone who has a sore throat, a cold, flu, mononucleosis, or bacterial infection.
• Wash your hands frequently.
• Don't smoke, and avoid exposure to secondhand smoke.
• Use a humidifier if the air in your home is dry.

If your doctor suspects that you have a sore throat caused by bacteria, he or she will prescribe an antibiotic. But if your sore throat is caused by a virus, there is no medicine that will cure it -- it will go away on its own. Cool air and humidity are suggested to relieve symptoms. In the meantime, your doctor may recommend gargling with salt water and taking an over the counter pain reliever such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin). Children under 18 should not take aspirin as a pain reliever, because of the risk of a rare but serious illness called Reye's syndrome.

Lifestyle

• Rest
• Drink lots of fluid. Water and warm broths are better than soft drinks
• Avoid drinking alcohol
• Gargle several times per day with ½ tsp. of salt in a glass of warm water
• Try throat lozenges (do not give to a child under 3 years old due to choking hazard).

Medications

If your sore throat is caused by a bacterial infection, your doctor will prescribe an antibiotic. Penicillin or, if you have an allergy to penicillin, erythromycin are most commonly prescribed.

Nutrition and Dietary Supplements

Because supplements may have side effects or interact with medications, you should take them only under the supervision of a knowledgeable health care provider. Be sure to talk to your physician about any supplements you are taking or considering taking.

There isn't much scientific evidence about which supplements might help treat a sore throat, or lessen your chances of getting a cold of flu. However, a few supplements and nutrients are worth trying:

• Warm liquids, such as soup or broth -- Soup and warm liquids (broth, tea) can help soothe a sore throat and loosen mucus, which in turn helps ease congestion from a cold.
• Probiotics (Lactobacillus) -- So called “good” bacteria or probiotics help prevent infections in the intestines, and there is preliminary evidence that they might help prevent colds, too. One study found that children in daycare centers who drank milk fortified with Lactobacillus had fewer and less severe colds. Several studies that examined probiotics combined with vitamins and minerals also found a reduction in the number of colds caught by adults, although it’s not possible to say whether the vitamins, minerals, or probiotics were most responsible for the benefit.
• Honey -- Honey is a traditionally remedy for sore throat and cough. A 2007 study found that honey given to children before bedtime did a better job of suppressing night time cough than dextromethorphan, a cough suppressant found in many over the counter cough syrups. Infants under one year old should not consume honey.
• Vitamin C -- Despite the popular belief that vitamin C can cure the common cold, the scientific evidence hasn't found that to be true. Only a small reduction in the duration of a cold (about 1 day) has been found when some people take vitamin C supplements regularly (not just at the beginning of a cold). The only other piece of evidence supporting vitamin C for preventing colds comes from studies examining people exercising in extreme environments (athletes such as skiers and marathon runners, and soldiers in the Arctic). In these studies, vitamin C did seem to reduce the risk of getting a cold. Talk to your doctor about any pros and cons with regards to using vitamin C during cold and flu season. Some people believe that you will only get the benefit of vitamin C by taking very high doses. They suggest taking a high enough dose to cause diarrhea and then backing off from there. You should only take such high doses of vitamin C under your doctor's supervision.
• Zinc -- Your body needs zinc for its immune system to function properly, so it has long been thought that zinc could help protect against catching a cold. But the evidence has been decidedly mixed, with some studies finding a benefit from zinc lozenges and others showing no effect. Recently, a review of studies that compared zinc to placebo found that most of them had flaws that made any positive results unreliable. Only four studies were deemed reliable, and three found no benefit from zinc lozenges. The remaining positive study suggested that zinc nasal sprays might help reduce nasal stuffiness. If you do decide to try zinc lozenges for a cold, remember that getting too much zinc (more than 50 mg per day over a long period of time) can be dangerous.

Herbs

The use of herbs is a time honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care practitioner. Before giving any herbs to a child to treat a cold, talk to your pediatrician.

To prevent colds and flu:

• Echinacea (Echinacea purpurea, 300 mg 3 times per day) -- Although evidence on whether echinacea works to prevent or treat colds has gone back and forth, recent evidence is encouraging. An analysis of 14 scientific studies found that people who took echinacea reduced their risk of getting a cold by 58% and reduced the duration of a cold by an average of a day and a half. However, many of the studies used echinacea in combination with another herb or vitamin, so it’s impossible to say which one was responsible for the benefit. Echinacea should not be used by women who are pregnant or breastfeeding, or by anyone taking drugs that suppress the immune system (such as corticosteroids or methotrexate).
• Andrographis (Andrographic paniculata) -- One study found that andrographis, an herb used in Ayurvedic medicine, combined with eleuthero or Siberian ginseng (Eleutherococcus senticosus) in a formula called Kan Jang, helped reduce cold symptoms. Andrographis should not be used by women who are pregnant or breastfeeding, or by anyone taking drugs that suppress the immune system (such as corticosteroids or methotrexate).
• Garlic (Allium sativum) -- In one study, people who took garlic for 12 weeks between November and February had 63 percent fewer colds than people who took placebo. Those who did get a cold recovered about one day faster. Because garlic can increase the risk of bleeding, people who take anticoagulants (blood thinners, such as aspirin or warfarin) should not take garlic. Women who are pregnant or breast-feeding should talk to their doctor before taking garlic supplements.
• Ginseng (Panax quinquefolius, 400 mg per day) -- At least two studies suggest that taking American ginseng may help prevent colds, as well as reduce the number of colds experienced and the severity of symptoms.

There are not many scientific studies that have examined which herbs might work to treat sore throat. These herbs have been used traditionally to relieve sore throat pain:

• Eucalyptus (Eucalyptus globulus) -- Eucalyptus is used in many remedies to treat cold symptoms, particularly cough. It can be found in many lozenges, cough syrups, and vapor baths throughout the United States and Europe. Fresh leaves can be used in teas and gargles to soothe sore throats. Do not consume the actual leaves. Ointments containing eucalyptus leaves are also applied to the nose and chest to relieve congestion and loosen phlegm. The essential oils in Eucalyptus may be too strong for some people, so start slowly.
• Licorice (Glycyrrhiza glabra) -- Licorice root is a traditional treatment for sore throat, although scientific evidence is lacking. Licorice interacts with a number of medications, so ask your doctor before taking it. People with high blood pressure or heart disease, women who are pregnant or breastfeeding, and those who take anticoagulants (blood thinners) should not take licorice.
• Marshmallow (Althea officinalis) -- Although there isn’t any scientific evidence that it works, marshmallow has been used traditionally to treat sore throat and cough.
• Peppermint (Mentha x piperita) -- Like eucalyptus, peppermint is widely used to treat cold symptoms. Its main active agent, menthol, is a good decongestant. Menthol also thins mucus and works as an expectorant, meaning that it helps loosen and break up phlegm. It is soothing for sore throats and dry coughs as well.
• Slippery elm (Ulmus fulva) -- Slippery elm may help ease a sore throat and has been used traditionally for this purpose, although scientific evidence is lacking.

Some people may find relief gargling or drinking these teas:

• Chamomile (Matricaria recutita)
• Sage (Salvia officinalis)
• Blackberry (Rubus fruticosus)

Homeopathy

There have been few studies examining the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend one or more of the following treatments for sore throat based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

• Aconitum -- for sore throats that come on suddenly after exposure to cold and are accompanied by a high fever and thirst; this remedy works best if given immediately after symptoms begin.
• Apis mellifica -- for shiny red, swollen throats with stinging, burning, and dry pains; this remedy is most appropriate for individuals who feel better with cold drinks but have little thirst; they may also have difficulty swallowing and may have the sensation of a fishbone being stuck in the throat; they also tend to be bothered by anything around the neck.
• Arsenicum album -- for a burning sensation in the throat accompanied by thirst, chills, and restlessness; symptoms are relieved by warm liquids; nasal discharge often occurs before the development of a sore throat.
• Belladonna -- usually the first homeopathic remedy considered for sore throats, particularly if there is sudden onset of intense pain on the right side of the throat along with redness, swelling, and a feeling of constriction; individuals also generally have a fever, may experience pain when swallowing (although the individual wants to drink despite the pain), and often describe a hot sensation in the throat; this remedy works best if used during the first 24 hours of throat soreness.
• Hepar sulphuricum -- for stinging throat pain that is often described as a stick in the throat; throat pain is often accompanied by enlarged tonsils; pain may extend to the ears and is generally better from warm drinks; individuals for whom this remedy is appropriate are often very irritable and sensitive to cold, touch, motion, noise, and light.
• Lachesis -- for throat pain with swelling that is initially worse on the left side but may spread to the right; symptoms are worsened by warmth, warm liquids, swallowing (including saliva), and constrictive clothing.
• Lycopodium -- for throat pain with a choking sensation, as if having a ball stuck in the throat; individuals for whom this remedy is appropriate often have pain that begins on the right side and may spread to the left; symptoms are relieved by warm drinks.
• Mercurius -- for throat pain accompanied by fever, weakness, red spots on the tonsils as well as possible pus, and bad breath; Mercurius is most appropriate for individuals who may be sensitive to both heat and cold and tend to salivate, drool, or perspire, particularly at night.
• Phytolacca -- for a dark red, purple, or bluish swollen throat accompanied by excessive aching, fever, and pain with swallowing; individuals for whom this remedy is appropriate may also have a shooting pain that extends to the ears, and an acute pain at the base of the tongue when protruded; these symptoms are worsened by warm drinks and motion.
• Rhus toxicodendron -- for throat pain accompanied by restlessness that is worse with initial swallowing, but is relieved by subsequent swallows as well as warm liquids; symptoms may be initiated by cold air or straining the voice.
• Sulphur -- for a burning, lingering sore throat; symptoms are worsened by warm drinks and food; tonsils tend to be swollen, breath may be foul, and gums and nasal passages are dry.

Prognosis and Complications

A sore throat usually goes away quickly on its own. If you have had a sore throat for more than a week, or you have a fever, swollen lymph nodes, or a rash, you should call your doctor right away. Fever, swollen lymph nodes, or a rash may indicate strep throat or a complication such as rheumatic fever. Strep throat requires antibiotics to prevent complications such as:

• Scarlet fever, which can cause fever and a particular type of rash
• Rheumatic fever, which can cause joint inflammation or damage your heart valves
• Glomerulonephritis (kidney inflammation)
• Infection in the bloodstream
• Shock
• Respiratory arrest, particularly among children with croup

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