Sore Throat

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DEFINITION

• Pain, discomfort or raw feeling of the throat, especially when swallowing.

General Information

• Sore throat is one of the most common reasons patients go to the doctor's office.
• The medical term for a throat infection is pharyngitis or tonsillo-pharyngitis.

Causes of Sore Throat

• Colds: Most sore throats are from a cold or other viral infection. The presence of a cough, hoarseness or nasal symptoms points to a cold or viral infection as the cause of the sore throat
• Strep Throat: In adults, approximately 10-20% of sore throats are caused by the streptococcus (strep) bacteria. Streptococcal pharyngitis is the only commonly occurring bacteria for which antibiotic therapy is definitely indicated.
• Mono: Infectious mononucleosis is primarily seen in young adults, causing 5-10% of the sore throats in that population. It should be suspected in young adults with fever, sore throat, swollen lymph nodes, and a negative strep throat culture. A blood test called a "monospot" can help make the diagnosis. There is no antibiotic treatment.
• Other common causes include dry air, smoking, post-nasal drip and yelling. Sexually transmitted diseases (e.g. gonorrhea) can also cause pharyngitis.

See More Appropriate Topic (instead of this one) If

• Sore throat occurs with a COLD
• Sore throat is mild and COUGH is the main symptom

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WHEN TO CALL YOUR DOCTOR

Call 911 Now (you may need an ambulance) If

• Severe difficulty breathing (e.g. struggling for each breath, unable to speak)

Call Your Doctor Now (night or day) If

• You feel weak or very sick
• Difficulty breathing and is not from a blocked or stuffy nose
• Fever of 103 F (39.4 C) or higher
• Signs of dehydration (e.g. no urine in more than 12 hours, very dry mouth, very lightheaded, etc.)
• New drooling (can't swallow fluids) or having great difficulty swallowing
• Unable to open mouth completely

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If:

• You think you need to be seen
• Sore throat pain is severe
• Pus on the tonsils (back of throat) along with fever
• Widespread rash (e.g. trunk and abdomen)
• Earache or sinus pain/pressure
• Fever has lasted longer than 3 days
• Exposure in the past 2 weeks to someone who had Strep Throat
• You have a history of having rheumatic fever
• You have diabetes mellitus or a weakened immune system (e.g. HIV positive, cancer chemotherapy, chronic steroid treatment, splenectomy)

Call Your Doctor During Weekday Office Hours If

• You have other questions or concerns
• Sore throat is the only symptom and lasts longer than 2 days
• Sore throat is mild and lasts longer than 4 days

Self Care at Home If

• Mild sore throat and you don't think you need to be seen

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HOME CARE ADVICE FOR MILD SORE THROAT

1. For Relief of Sore Throat Pain:
   • Sip warm chicken broth or apple juice.
   • Suck on hard candy or a throat lozenge (over the counter).
   • Gargle warm salt water three times daily (1 teaspoon of salt in a 8 oz of warm water).
   • Avoid cigarette smoke.
   Pain Medication:
   • For pain relief, take acetaminophen or ibuprofen
   • Acetaminophen (e.g., Tylenol): The dose is 650 mg by mouth every 4 hours or 1000 mg by mouth every 6 hours. Maximum dose per day = 4000 mg.
   • Ibuprofen (e.g., Motrin, Advil): The dose is 400 mg by mouth every 6 hours or 600 mg by mouth every 8 hours.
   • People who are over 65 Years of age: Acetaminophen is generally considered safer than ibuprofen. Acetaminophen dosing interval should be increased to every 8 hours because of reduced liver metabolism. Maximum dose per day = 3000 mg.
   • CAUTION: Do not take ibuprofen if you have stomach problems, kidney disease, are pregnant, or have been told by your doctor to avoid  this type of anti-inflammatory drug. Do not take ibuprofen for more than 7 days without consulting your doctor.
   • CAUTION: Do not take acetaminophen if you have liver disease.
   • Read the package instructions thoroughly on all medications that you take.
2. Fever Medication:
   • For fevers above 101 F (38.3 C) take acetaminophen or ibuprofen. The goal of fever therapy is to bring the fever down to a comfortable level. Remember that fever medicine usually lowers fever 2 degrees F (1- 1 1/2 degrees C).
   • Acetaminophen (e.g., Tylenol): The dose is 650 mg by mouth every 4 hours or 1000 mg by mouth every 6 hours. Maximum dose per day = 4000 mg.
   • Ibuprofen (e.g., Motrin, Advil): The dose is 400 mg by mouth every 6 hours or 600 mg by mouth every 8 hours.
   • People who are over 65 Years of age: Acetaminophen is generally considered safer than ibuprofen. Acetaminophen dosing interval should be increased to every 8 hours because of reduced liver metabolism. Maximum dose per day = 3000 mg.
   • CAUTION: Do not take ibuprofen if you have stomach problems, kidney disease, are pregnant, or have been told by your doctor to avoid  this type of anti-inflammatory drug. Do not take ibuprofen for more than 7 days without consulting your doctor.
   • CAUTION: Do not take acetaminophen if you have liver disease.
   • Read the package instructions thoroughly on all medications that you take.
3. Do not take ibuprofen if you have stomach problems, kidney disease, are pregnant, or have been told by your doctor to avoid this type of anti-inflammatory drug. Do not take ibuprofen for more than 7 days without consulting your doctor.
   • Do not take acetaminophen if you have liver disease.
   • Read the package instructions thoroughly on all medications that you take.
4. Soft Diet: Cold drinks and milk shakes are especially good. (Reason: swollen tonsils can make some foods hard to swallow.)
5. Liquids: Adequate liquid intake is important to prevent dehydration. Drink 6-8 glasses of water a day.
6. Contagiousness: You can return to work or school after the fever is gone and you feel well enough to participate in normal activities. If your doctor determines that you have Strep throat, then you will need to take an antibiotic for 24 hours before you can return.
7. Expected Course: Sore throats with viral illnesses usually last 3 or 4 days.
8. Call Your Doctor If:
   • Sore throat is the main symptom and it lasts longer than 24 hours
   • Sore throat is mild but lasts longer than 4 days
   • Fever lasts longer than 3 days
   • You become worse

And remember, contact your doctor if you develop any of the "Call Your Doctor" symptoms.