Acute and chronic pharyngitis across the lifespan

Although most instances of sore throat are caused by relatively benign infectious or noninfectious processes, pharyngitis may herald serious or even fatal illnesses. Viral pharyngitis is the diagnosis in most cases, but because GABHS is the most common bacterial organism requiring antimicrobial treatment, an office visit is often necessary. There is no exact constellation of signs and symptoms that is pathognomonic for GABHS; nevertheless, sudden onset of sore throat with fever and cervical lymph node tenderness, in the absence of cough and nasal symptoms, is at least suggestive in adults, and possibly in children. Physical examination and prudent use of laboratory testing will assist in the diagnosis of both acute and chronic pharyngitis. The primary care provider who promptly identifies and properly treats patients infected with S. pyogenes has reduced the number of missed school or work days, the risk of developing ARF, the likelihood of transmission to others, and inappropriate use of antibiotics for those with other causes of sore throat. Further education of patient, family, and other clinicians will reduce medical expenses, avoid unnecessary antibiotic exposure, and inform the public regarding judicious management of pharyngitis.