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Pharyngitis is infection of the throat (pharynx) and sometimes the tonsils.

• Pharyngitis is usually caused by a virus and clears up on its own.
• Occasionally, it is caused by certain bacteria (particularly those called streptococci) and results in strep throat.
• The throat is sore and red, swallowing is painful, and the tonsils may be enlarged or coated white.
• The diagnosis is usually based on symptoms, but if strep throat is suspected, doctors may take a swab from the back of the throat and test it.
• Ibuprofen
  
  or acetaminophen
  
  and plenty of fluids are recommended for all sore throats, plus penicillin for strep throat.

Most pharyngitis is caused by the same viruses that cause the common cold. Like the common cold, viral pharyngitis resolves on its own and is a problem only because it makes children miserable and causes them to miss school. Streptococcus bacteria (streptococci) are a less common but more serious cause of pharyngitis (strep throat). Strep throat is unusual in children younger than 2 years. Rarely, pharyngitis is caused by unusual infections, such as infectious mononucleosis (which is due to a virus) or, in countries with low vaccination rates, diphtheria.

The tonsils (patches of lymphoid tissue at the back of the throat) can also become infected in children with pharyngitis. A doctor may use the term tonsillitis when the tonsils are particularly enlarged. Occasionally, the tonsils remain infected, inflamed, or enlarged after an episode of pharyngitis.

Pharyngitis due to bacteria can cause the following:

• Persistent inflammation, infection, and enlargement of the tonsils (chronic tonsillitis)
• Pus within folds of the tonsils (cryptic tonsillitis)
• Abscesses in the tissues to the side of the pharynx (lateral pharyngeal abscesses), behind the pharynx (retropharyngeal abscesses), or around the tonsils (peritonsillar abscesses—see Throat Disorders: Tonsillar Cellulitis and Abscess)

Rarely pharyngitis due to streptococci causes rheumatic fever (see Bacterial Infections: Rheumatic Fever), glomerulonephritis, or a life-threatening infection of the tissues (necrotizing fasciitis) or bloodstream (toxic shock syndrome).

Symptoms

All children with pharyngitis have a sore throat and some degree of pain when they swallow. The ears may be painful because the throat and ears share the same nerves. The back of the throat and tonsils are typically red, and the tonsils may be enlarged or coated with a white discharge.

Children with pharyngitis as part of a head cold have a runny nose, cough, and slight fever.

Children with strep throat may have tender, enlarged lymph nodes in the neck and a high fever. A few children with strep throat have symptoms of scarlet fever (see Bacterial Infections: Streptococcal Infections), which include bright white or red changes of the tongue (strawberry tongue) and a distinctive red skin rash (scarlatiniform rash).

Children with chronic tonsillitis may have a sore throat or discomfort or pain when they swallow.

Diagnosis and Treatment

Doctors suspect pharyngitis when they see redness and a white discharge or pus in the back of the throat and when the lymph nodes in the neck are enlarged.

If doctors suspect strep throat, they may take a swab from the back of the throat and send it for two tests: rapid antigen testing and a bacterial culture. Rapid antigen testing can detect strep throat within minutes. If the result of a rapid test is positive, the bacterial culture is not needed. However, if the result of the rapid test is negative, a culture is usually done. Culture takes about 1 to 2 days for results.

Strep throat is usually treated with penicillin in a single injection or over 10 days by mouth. If children are allergic to penicillin, doctors may use erythromycin

or another antibiotic. Treatment of strep throat and pharyngitis due to a virus includes giving ibuprofen

oracetaminophen

for pain and fever and encouraging children to drink fluids. Providing soup is a good way to keep children well hydrated and nourished when swallowing is painful and before their appetite has returned. Gargling with salt water or using an anesthetic throat spray may also help temporarily relieve pain.