Ask the Pharmacist

Q) I really hate going up to the emergency room at the hospital every time I get a sore throat. It takes such a long time to see someone and seems like such a waste of money and healthcare resources. How can I tell when I really need to see a doctor?

A) A sore throat is known in healthcare as acute pharyngitis. Technically speaking, this means there is inflammation of the pharynx which is the part of the throat that is behind the mouth but above the esophagus. The esophagus is responsible for bringing food down to the stomach.

Pharyngitis is one of the most common reasons people drop into the emergency ward or visit urgent care clinics in other communities. In a recent study, 16% of adults and 41% of children reported an illness involving a sore throat over a 1 year time frame.

The incidence of pharyngitis usually peaks during the late winter and early spring. It is normally very contagious as it spread by droplets that are left hanging in the air or attached to hands after coughing or sneezing. The vast majority of cases in adults (somewhere in the 80 to 90% range) are caused by a virus, meaning that there is nothing a doctor can do to speed up your recovery.

In pediatrics, while the cause is still more likely to be a virus, a full 37% of cases are caused by group A streptococcus (the so called strep throat or GAS) and will require a trip to the doctor and the prescribing of appropriate antibiotics (usually penicillin or a derivative of it).

The key is to help patients understand when it is appropriate to invest your time waiting at the clinic. For some people, any sign of infection there is a need for a visit with the doctor due to their increased likelihood of getting very sick very quickly. These would be people who are immune suppressed such as those undergoing cancer treatments or taking certain drugs (such as prednisone or many of the biologics which treat autoimmune disorders), the very young or in people who have been diagnosed with certain medical conditions. Viral pharyngitis in people who are otherwise healthy doesn’t last long, goes away on its own and does not cause any long-term consequences.

Unfortunately GAS forms of pharyngitis can lead to serious complications if left untreated such as glomerulonephritis (a kidney disorder), and rheumatic fever which could potentially permanently damage the valves of the heart. As such, these types of infections need to be identified and treated.

In order to help patients decide, researchers have come up with a numerical system whose scoring will hopefully help with your decision making. If your score is equal to or less than 1, no treatment or testing (i.e. the dreaded throat swab) is necessary. If your score is in the 2 to 3 range, a throat culture is advisable and whether to treat or not should be decided when the results come in the next few days. If your score is 4 or higher, antibiotic treatment should be initiated immediately and only stopped if testing comes back negative. Your score is based upon your age and your symptoms.

Age Scoring:

3-14 = 1
14-44 = 0
45 plus = -1

Symptoms scoring:

Fever greater than or equal to 38C (101F) = 1
No cough = 1
Swollen lymph nodes in the neck = 1
Red tonsils or a pussy exudates at the back of the throat = 1

Those people that are under 3 years of age should always be seen by a healthcare professional as should those who exhibit symptoms that indicated they have a more complicated form of the infection. These symptoms include;

· Drooling
· Difficulty swallowing
· Severe unilateral (one-sided) neck pain/ stiffness
· Severe headache
· Skin rash
· Confusion
· Vital sign abnormalities (rapid heart rate or breathing or a sudden lowering of the blood pressure)

For those of us who really do not need to see a doctor there is still plenty one can do to help themselves feel better. Remember, just because your sore throat may not be caused by GAS does not mean you are not really sick. Self-care that can make a difference include;

· Gargling with warm salty water to ease throat pain
· Taking ibuprofen (Advil), Aleve (naproxen) or acetaminophen (Tylenol) as needed if you are allowed those medications
· Getting plenty of rest to allow your immune system to fully recharge
· Drinking plenty of water to prevent dehydration
· Using a cool mist vaporizer to relieve throat dryness
· Using throat lozenges or sprays on an as needed basis
· Drinking warm liquids (like tea) or cool liquids (like a flavoured ice) to soothe the throat

Regardless of whether the causative agent is a virus or bacteria, your prognosis is excellent. Almost everyone recovers in short order without any issues complicating their lives going forward. For more information about this or any other health related topics, contact your pharmacist.