1. What is a Sore Throat?
A sore throat refers to pain, itchiness, or irritation of the throat. You may have
difficulty swallowing food and liquids, and the pain may get worse when you try to
swallow. Throat pain is the primary symptom of a sorethroat. However, other
symptoms may include a dry throat, swollen glands in the neck, white patches on
the tonsils, and hoarseness.
Causes of a Sore Throat
There are several causes of a sore throat.
Viral Infection
The majority of sore throats are triggered by a viral infection. These are infections
caused by a virus, such as the cold and flu.
Other types of viral infections include:
 mononucleosis: infectious disease typically transmitted through saliva
 measles: contagious illnesses characterized by a distinct rash and fever
 chickenpox: infection that causes skin sores
 croup:infection of the larynx
BacterialInfection
A bacterial infection can also cause a sorethroat. These types of infections include:
 strep throat: inflammation of the throat caused by the Streptococcal bacteria
 diphtheria: infectious disease that causes throat inflammation
 whooping cough: disease of the respiratory mucous membrane
Environmental Factors
Not all sore throats are viral or bacterial. There are several other causes of throat
pain. If you’re allergic to mold, pet dander, pollen, or other irritants, exposure to
these allergens can trigger post-nasal drip. This is when excess mucus accumulates

2. in the back of your throat. This accumulation can irritate your throat and cause pain
or inflammation.
Dry air can also make your throat feel raw and scratchy. Smoking cigarettes or
exposure to cigarette smoke can trigger persistent sore throats, as well as throat
strain from yelling or too much talking.
GERD
Gastroesophagealreflux disease may also cause your sore throat. This is a
digestive condition characterized by the back flow of stomach acid into the
esophagus. This condition causes an array of symptoms, such as a sore throat,
hoarseness, heartburn, and nausea.
Other Causes
In very rare cases, a sore throat may be a sign of HIV or throat cancer.
Diagnosing a Sore Throat
Most sore throats do not require medical attention. However, see a doctorif your
sore throat lasts for longer than one week and if you experience:
 difficulty breathing
 joint pain
 difficulty swallowing
 an earache
 a rash
 fever over 101 degrees F
 bloody mucus
 a lump in the throat
 hoarseness for longer than two weeks
Determining the cause of your sore throat can help your doctortreat your
symptoms. Your doctorwill do a physical examination and examine your throat

3. with a lighted instrument. He or she will look for signs of inflammation or white
patches, which might indicate strep throat. Your doctorwill also feel your neck for
swollen glands and check your breathing.
Because strep throat is a common cause of sorethroats, your doctormay swab the
back of your throat and examine the sample for the Streptococcal bacteria. He or
she may also run a blood test to determine whether you have a viral or bacterial
infection.
If your doctoris unable to diagnose your sore throat, he or she will refer you to an
allergist or an ear, nose, and throat specialist. These specialists will determine
whether allergens or a throat disorder is the cause of your sore throat.
Note that it can be difficult to diagnose a sorethroat in infants and toddlers. In this
age group, refusal to eat is a common sign of throat irritation.
How to Treat a Sore Throat
The treatment for a sore throat depends on the cause. However, you can treat many
sore throats at home. Home treatment options include:
 gargling with warm salt water
 drinking plenty of warm fluids, such as teas, soup, and water
 avoiding allergens and irritants, such as smoke and chemicals
 taking throat lozenges
 reducing inflammation with ibuprofen or acetaminophen
If a bacterial infection causes your sore throat, your doctorwill prescribe a course
of antibiotics to kill the infectious organisms. You should take your medication for
10 days or as prescribed by your doctorto treat the bacterial infection. A sore
throat may recur if you stop treatment early.
If you have a viral infection, your doctormay want to let the virus run its course.
During that time, he or she may prescribe medications, such as decongestants and

4. pain relievers, to ease your symptoms. In some cases, your doctormay want to try
an antiviral drug to fight the virus.
Complications of a Sore Throat
In the case of persistent bacterial throat infections, your doctormay recommend a
tonsillectomy to surgically remove the tonsils. This is a last resort treatment that
should only be considered when sore throats do not respond to antibiotics.
How to Prevent a Sore Throat
Many underlying causes of sore throats are infectious, and there are certain steps
you can help you prevent future infection. Repeatedly washing your hands
throughout the day kills germs and bacteria that can cause viral and bacterial
infections. Additional steps that you can take to prevent a sore throat include:
 Do not share drinking glasses or utensils with others.
 Use hand sanitizers whenever soap and water are not available.
 Limit contact with commonly touched surfaces.
 Reduce exposure to allergens, such as pollen, dust, and mold.
 Avoid cigarette smoke.
 Keep a humidifier in your house to eliminate dryness.
What is the bestantibiotic for Strep Throat?
According to the recent research, Penicillin is still considered the best
choice to treat streptococcal pharyngitis (for those non-allergic to
penicillins).
Cephalosporins are superior for relapse and reccurent infections.
Penicillin
Since its introduction in the 1940s, penicillin has been the “gold standard”
antibiotic for strep throat and still remains the drug of choice in most cases.
Over the past 50 years the ability of penicillin to kill group A streptococci

5. has not changed. There has never been a group A streptococcus grown
from a human that has been resistant to penicillin.
Penicillin has proven efficacy and safety. It has a narrow-spectrum and so
does not promote antimicrobial resistance.
Penicillin V dosage:
 Children: 250 mg two or three times daily for 10 days
 Adults: 500 mg two or three times for daily 10 days
Benzathine penicillin G (intramuscular):
When a patient is unlikely to complete the entire course of oral antibiotic, a
single intramuscular dose of penicillin G benzathine (Bicillin L-A) is an
option.
 <27 kg: 600 000 U, 1 dose
 ≥27 kg: 1 200 000 U, 1 dose
Amoxicillin
Amoxicillin, a broader spectrum penicillin, has the advantage of more
convenient treatment regimen. Some studies show that amoxicillin given
just once a day may work as well as penicillin V given more often.
Amoxicillin suspensions taste better than penicillin V suspensions.
However, Amoxicillin has no microbiologic advantage over the less
expensive penicillin. Gastrointestinal side effects and skin rash are more
common with amoxicillin.
Amoxicillin dosage:
 Children: 40 mg/kg per day in three divided doses for 10 days
 Adults: 500 mg three times daily for 10 days
Amoxicillin/Clavulanate Potassium (Augmentin) is resistant to
degradation from beta-lactamase produced by pathogens that may
colonize the tonsils and pharynx. Amoxicillin-clavulanate is often used to
treat recurrent streptococcal pharyngitis. Its major adverse effect is
diarrhea. Also it is expensive.

6. Amoxicillin/Clavulanate Potassium dosage:
 Children: 40 mg/kg per day, in two or three divided doses for 10 days
 Adults: 500 to 875 mg two times daily for 10 days
Alternative antibiotics must be used in patients with penicillin allergy, poor
compliance or penicillin treatment failure. Patients who do not respond to
initial treatment should be treated with antibiotic that is not inactivated by
penicillinase-producing organisms (e.g., amoxicillin-clavulanate potassium,
a cephalosporin or a macrolide).
Azithromycin: brand name .zetro 250mggetz pharma
Azithromycin (Zithromax), ZITAMAX (ZITHROMAX) PFIZER LABORATORIES
a macrolide antibiotic, is an effective treatment for group A streptococcal
pharyngitis and is considered a second-line therapy.
It is a reasonable choice for patients:
 allergic to penicillins
 unwilling to a 10-day regimen
 who fail therapy with penicillin antibiotics2
.
Azithromycin produces high tonsillar tissue concentrations. Azithromycin
has a similar effectiveness to old erythromycin but causes less
gastrointestinal side effects. Also, it provides very simple and short dosing
regimen.
Azithromycin dosage (5-day course):
 Children: The recommendeddosage is 12 mg/kg once daily for5 days. Or,
alternatively, 20 mg/kg once daily for 3 days.
12 mg per kg for 5 days once daily for 5 days
 Adults:The recommended dosage is 500 mg as a single dose on the first
day, followed by 250 mg once daily for 4 days 1
.
Clarithromycin; brand tab; claritek 550mg GETZ PHARMA PAKISTAN
Clarithromycin (Biaxin) is reasonable for patients allergic to penicillin. One
study suggests that 10 days of clarithromycin may be more effective in
eradicating group A streptococcithan 5 days of azithromycin

7. Clarithromycin dosage:
 Children: 7.5 mg/kg/dose twice daily for 10 days.
 Adults: 250 mg every 12 hours for 10 days.
Clindamycin
Clindamycin resistance among GAS isolates in the United States is
approximately 1%, and this is a reasonable choice for treating penicillin-
allergic patients 4
.
Clindamycin dosage:
 Children: 7 mg/kg/dose 3 times daily for 10 days.
 Adults: 600 mg daily in 2-4 divided doses given for 10 days.
Cephalosporins
Several studies indicate that a 10-day course of a cephalosporinis superior
to penicillin in eradicating group A beta-hemolytic streptococci5
.
Cephalexin
Narrower-spectrum cephalosporins such as cefadroxil or cephalexin are
preferable to the broader-spectrum cephalosporins such as cefaclor,
cefuroxime, cefixime, and cefpodoxime.
Cephalexin dosage:
 Children: 25 to 50 mg/kg per day in two to four divided doses for 10 days
 Adults: 500 mg two times daily for 10 days
Cefadroxil
Cefadroxil allows a once daily dosing, has a low incidence of
gastrointestinal side effects and a good taste.
Cefadroxil dosage:
 Children: 30 mg/kg once daily for 10 days
 Adults: 1 g daily as a single dose or in 2 divided doses for 10 days

8. Cefuroxime axetil
Currently, the recommended course of cefuroxime for strep throat is 10
days. However, clinical studies have demonstrated that short-course (4-5
day) treatment with cefuroxime axetil is also very effective in eradicating
the infection and preventing post-streptococcal sequelae.
Also, short course of cefuroxime axetil (20 mg/kg/day, max. 500 mg, in two
divided doses for5 days) is effective treatment for children aged 1-17 years
with streptococcal tonsillopharyngitis
Cefuroxime axetil dosage:
 Adults and adolescents and (13 years and older): 250 mg two times
daily for 10 days
Cefdinir
Cefdinir (Omnicef) is an extended-spectrum oral cephalosporin with potent
antistreptococcalactivity. The FDA has approved the use of a 5-day course
of Cefdinir for the treatment of streptococcal pharyngitis. 5-day course of
Cefdinir is equal to the standard 10-day treatment with penicillin V3
.
However, Cefdinir provides a slightly higher eradication rate of group A
streptococcus bacteria.
Unsuitable antibiotics
Antibiotics NOT recommended for streptococcal pharyngitis:
 Metronidazole - not active against Streptococcus pyogenes
 Trimethoprim-Sulfamethoxazole (Co-trimoxazole, Bactrim) - does not
reliably eradicate pharyngeal infection
 Tetracyclines - the high prevalence of resistant Streptococcus
pyogenesstrains.
 Fluoroquinolones - are expensive and have an unnecessarily broad
spectrum of activity.