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Sore Throat

Pharyngotonsillitis is an inflammation of the pharynx and the tonsils. Its main symptom is a sore throat. On rare occasions isolated inflammations of the pharynx (pharyngitis) or the tonsils (tonsillitis) occur. They share the same causes, progression and treatment with pharyngotonsillitis, and have a sore throat as their main symptom as well.


Viruses (rhinoviruses, coronaviruses, influenza, adeno, herpes, EBV and others) are the main cause of pharyngotonsillitis, present in 70-80 % cases. Bacterial pharyngotonsillitis is rather rare. Group A beta hemolytic streptococcus (s.pyogenes) is the main causative agent in those cases. In some rare cases the disease might be caused by staphylococcus or gonococcus (which causes gonorrhea).

Signs and symptoms

The main symptoms of pharyngotonsillitis are sore throat and difficulty when swallowing. The forms of pharyngotonsillitis are:

  • Catarrhal (a reddish and painful pharynx, typical of viral infections)
  • Follicular (abscesses can be seen, typical of s.pyogenes infections)
  • Lacunar (white patches on tonsils, typical of streptococcal infections)
  • Ulcerative (small ulcers seen in pharynx; common in viral infections)

Viral pharyngotonsillitis starts gradually. The first symptoms are those of a common cold. They are followed by a runny nose, cough, a hoarse voice, conjunctivitis (inflammation of the conjunctiva). If the disease is caused by a bacteria, it typically starts acutely, the whole body becomes intoxicated (especially in children) - nausea, vomiting, head aches, swollen lymph nodes in the neck are very common, as well as a fever. If the causative agent is streptococcus, the temperature raises and falls many times. A runny nose, cough and conjunctivitis are rather uncommon in bacterial infections.


Pharyngotonsillitis is a very common disease. Detection of the specific causative agent is not required to diagnose pharyngotonsilitis. The disease is diagnosed based on its clinical symptoms and a throat exam. Signs of inflammations can be observed in a blood test, which is sometimes performed. It is important to differentiate between viral and bacterial infections, because the treatment is different.


The treatment of pharyngotonsillitis is symptomatic if the causative agent is a virus. A bed regime and drinking lots of fluids is very important. Paracetamol (acetaminophen), nimesulide and other anti-inflammatory drugs are used in treating throat ache. In this case antibiotics are ineffective and may even be harmful.

Antibiotics are used to treat bacterial pharyngotonsillitis. Most widely used are ampicillin and amoxicillin. In addition, cephalosporins and macrolides can also be used. Two days after initiating antibacterial treatment, the symptoms should disappear (this proves that the infection was indeed bacterial). However, even if the symptoms persist, antibiotic treatment should be continued. The treatment of pharyngotonsillitis lasts 10 days.


The main complication of a viral pharyngotonsillitis is a bacterial infection. The complications of a bacterial pharyngotonsillitis are pneumonia, abscesses, endocarditis and rheumatic fever.


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