ADULT PHARYNGITIS (SORE THROAT)

RN First Call Certified Practice
Adult Decision Support Tool: EAR, NOSE AND THROAT – PHARYNGITIS
This decision support tool is based on best practice as of February 2009. For more information or to
provide feedback on this or any other decision support tools, e-mail certifiedpractice@crnbc.ca

ADULT PHARYNGITIS (SORE THROAT)

DEFINITION
Inflammation or infection of the mucus membranes of the pharynx. It may also affect the palatine tonsils.

POTENTIAL CAUSES
Infectious
Viruses
Rhinovirus
Adenovirus
Parainfluenzae
Coxsackievirus
Epstein-Barr
Herpes
Bacterial
Group A beta-haemolytic strep
Chlamydia
Diphtheria
H. Influenzae
Neisseria Gonorrhea
Fungi
Candida albicans (immuno-compromised)

Non-infectious
Allergic rhinitis
Sinusitis with post nasal drip
Mouth breathing
Trauma
GERD (gastroesophageal reflux disease)

PREDISPOSING RISK FACTORS
Crowded living quarters
Immuno-suppression
Fatigue
Smoking
Excessive consumption of alcohol
Oral sex
Diabetes Mellitus
Steroids, oral or inhaled

THIS DST IS FOR USE BY REGISTERED NURSES CERTIFIED BY CRNBC
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© CRNBC July 09/Pub. 709

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RN First Call Certified Practice
Adult Decision Support Tool: EAR, NOSE AND THROAT – PHARYNGITIS
TYPICAL FINDINGS OF PHARYNGITIS
History (Bacterial)
Abrupt onset of sore throat
Pain with swallowing
Absence of cough
Fever or chills
Malaise
Headache
Anorexia
Allergies
Medications currently used (prescription and OTC)
Herbal preparations

Physical Assessment
Temperature elevated
Pulse elevated
Client appears ill
Posterior pharynx red and swollen
Tonsils enlarged, may be asymmetric
Purulent exudate may be present
Tonsillar and anterior cervical nodes may be enlarged and tender
Skin rash may be present (scarletina)
Headache
Anorexia
liver/spleen enlargement +/- tenderness (i.e., mononucleosis)

History (Viral)
Slow progressive onset of sore throat
Mild malaise
Cough
Nasal congestion
Allergies
Medications currently used (prescription and OTC)
Herbal preparations

Physical Assessment
Temperature elevated
Posterior pharynx red and swollen
Purulent exudate may be present
Tonsillar and anterior cervical nodes may be enlarged and tender
Petechiae on palate (mononucleosis)
Vesicles (if herpes)



THIS DST IS FOR USE BY REGISTERED NURSES CERTIFIED BY CRNBC
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© CRNBC July 09/Pub. 709

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RN First Call Certified Practice
Adult Decision Support Tool: EAR, NOSE AND THROAT – PHARYNGITIS
Non-infectious
Slow progressive onset of sore throat
Mild malaise
Cough
Persistent, recurrent
Pain on swallowing
Posterior pharynx red and swollen
Tonsillar and anterior cervical nodes may be enlarged and tender
Exudate may be present

Note: It is often impossible to distinguish clinically between bacterial and viral pharyngitis. See the clinical tool
“Indicators that increase or decrease the likelihood of strep throat”, Appendix 1, to help differentiate whether a
person has Group A strep throat infection and needs antibiotics.

Diagnostic tests
Throat swab for C and S

MANAGEMENT AND INTERVENTION
Goals of treatment
Eradicate infection
Prevent complications
Prevent spread of group A streptococcus

Non-pharmacologic interventions
Bed rest during febrile phase
Adequate oral intake of fluids
Avoidance of irritants
Gargling with warm saline

Pharmacological Interventions
Use acetaminophen (Tylenol) 325-500 mg, 1-2 tabs PO Q4H prn or Ibuprofen (Motrin) 200mg, 1-2 tabs PO Q4H prn
Treat with antibiotics if streptococcal disease is suspected such as Penicillin V potassium (Pen Vee K) 300
mg PO tid or 600 mg PO bid for 10 days
Or if patient allergic to penicillin use Erythromycin (E-Mycin), 250 mg PO qid or 500 mg PO bid for 10 days.
DO NOT USE AMPICILLIN OR AMOXICILLIN, BECAUSE THESE DRUGS MAY CAUSE A
GENERALIZED RED “DRUG RASH’ IF INFECTIOUS MONONUCLEOSIS IS PRESENT.

POTENTIAL COMPLICATIONS
Rheumatic fever (group A strep)
Glomerulonephritis (group A strep)
Peritonsillar abscess

CLIENT EDUCATION AND DISCHARGE INFORMATION
Gargle frequently with warm salt water
Increase room humidity
Eat soft bland foods
THIS DST IS FOR USE BY REGISTERED NURSES CERTIFIED BY CRNBC
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© CRNBC July 09/Pub. 709

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RN First Call Certified Practice
Adult Decision Support Tool: EAR, NOSE AND THROAT – PHARYNGITIS
MONITORING AND FOLLOW UP
Return to clinic if not improved in 24-48 hours

CONSULTATION AND/OR REFERRAL
A consultation may be necessary if condition is recurrent or persistent or an undiagnosed underlying
pathology is suspected.
An immuno-compromised patient, or an unusual presentation of Candidiasis, should be referred promptly

DOCUMENTATION
Document according to agency policy

REFERENCES
BC Health Services (2003) Guidelines and Protocols: Diagnosis and management of sore throat.
http://www.health.gov.bc.ca/gpac/pdf/throat.pdf
Cooper, RJ., Hoffman, JR., Bartlett, JG., Besser, RE., Gonzales, R., Hickner, JM. et al. (2001) Principles of
appropriate antibiotic use for acute pharyngitis in adults: background. Arch Intern Med.134 (6):509-17.
http://www.caep.ca/page.asp?id=1549732C16E146AFACCA8417DEC7FA49
First Nations and Inuit Health Branch (2006) Clinical practice guidelines for primary care nurses. Health Canada
Ministry of Health BC (2006) BC Health Guide. Sore throat.
Toronto Notes (2006) Comprehensive Medical Reference and Review. University of Toronto
Worral, G.,Hutchinson, J., Sherman, G., Griffiths, J. (2007) Diagnosing streptococcal sore throat in adults.
Canadian Family Physician. Retrieved May 3, 2007 from, http://www.cfpc.ca/cfp/2007/apr/_pdf/vol53-apr-
research-worrall.pdf

APPENDIX 1


Source: BC Health Services. Guidelines and Protocols: Diagnosis and Management of Sore Throat
THIS DST IS FOR USE BY REGISTERED NURSES CERTIFIED BY CRNBC
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