Sore throat is a very common symptom in both children and adults, usually accompany with symptom of sneezing and coughing. It is also a common cause of presentation to medical practitioners and accepted by public as common cold.

Sore throat is a frequent indication of antibiotic prescription in the community, resulting in significant healthcare costs and may potentially contribute to increasing antimicrobial resistance with widespread and inappropriate use of antibiotics.

In a 1984 hospital-based study involving three general hospitals in Kuala Lumpur, Kota Baru and Ipoh, acute respiratory infections (ARIs) was responsible for 44.1 % of all paediatric admissions. Undoubtedly ARIs is the most common reason for seeking treatment in general practice and hospital outpatient departments.

Causative agent

Viral pathogens are more frequent causes of sore throat compared to bacterial pathogens.

Group A Streptococci is the most common bacterial cause of acute pharyngitis ,accounting for approximately 15-30% of cases in children and is also the only common form of pharyngitis for which antibiotic therapy is indicated.

Signs & Symptoms

Symptoms of a common cold usually appear about one to three days after exposure to a cold virus. Signs and symptoms of a common cold may include:

• Runny or stuffy nose
• Itchy or sore throat
• Cough
• Congestion
• Slight body aches or a mild headache
• Sneezing
• Watery eyes
• Low-grade fever
• Mild fatigue

In sore throat that are due bacterial infection, signs and symptoms as below:

• Symptom in child or adult commonly present with high grade fever and toxic (more ill).

Symptoms

sudden onset of sore throat, pain on swallowing, fever, headache, abdominal pain, nausea and vomiting.

Signs

tonsillopharyngeal erythema, tonsillopharyngeal exudate, softpalate petechiae; beefy-red swollen uvula, swollen and tender anterior cervical lymph nodes and rash. Not all patients have the full-blown syndrome and many cases are milder and do not have exudates.

Complications

Most cases of sore throat will end up without any complication.

Complications of Group A Streptococcal pharyngitis include both suppurative and nonsuppurative.

Suppurative complications are peritonsillar abscess (PTA) and retropharyngeal abscess (RPA). Peritonsillar abscess is the most common complication of acute tonsillitis. 15-36% of patients with PTA had prior history of oropharyngeal infections.

Nonsuppurative complications include acute rheumatic fever, acute post streptococcal glomerulonephritis and reactive arthritis. The most important nonsuppurative complication is acute rheumatic fever which occurs approximately 3 weeks after streptococcal pharyngitis.

Prevention

Management of sore throat include :

Symptomatic treatment

Virus is the most causative agent in sore throat. Symptomatic measures are usually adequate.

1. General measures include maintain adequate fluid intake and warm water gargle.
2. Paracetamol is an effective and safe analgesic and antipyretic. It is the drug of choice for analgesia in sore throat. Aspirin is not recommended for general use especially in children because of the risk of Reye’s syndrome.
3. Non-Steroidal Anti-inflammatory Drugs (NSAIDs). Ibuprofen (NSAIDs) has been used increasingly in the recent years for the treatment of pain and fever in children as well as adults with sore throat.
4. Throat lozenges and gargles are frequently used and are helpful especially in those with significant throat pain or discomfort.

Antibiotic therapy

Only a small percentage of sore throat is due to bacteria (Group A Streptococci) that will cause acute rheumatic fever. Antibiotics reduce the incidence of both suppurative and non-suppurative complications of sore throat. Therefore, for a patient with acute pharyngitis, the clinical decision that usually needs to be made is whether the pharyngitis is attributable to group A streptococci.

Patients with acute streptococcal pharyngitis should receive therapy such as penicillin and semi synthetic penicillin’s like ampicillin and amoxicillin. Erythromycin is a suitable alternative for patients allergic to penicillin.

Surgical treatment, including tonsillectomy

Recurrent episodes of sore throat in children with obstruction symptom such as snoring may indicate tonsillectomy after consulting ENT specialist.

In peritonsillar abscess or quinsy, tonsillectomy is indicated when the abscess failed to respond to appropriate antibiotics together with incision and drainage. Tonsillectomy is also indicated if patients develop quinsy and has a history of recurrent tonsillitis.