Pharyngitis usually isn’t serious

Dear Doctor K: I saw my doctor last week, who said I had acute pharyngitis, but didn’t say what that was. It sounds serious. What is it?

Answer: Good news: It’s rarely serious. Acute pharyngitis simply means that your throat has become inflamed by something, usually an infection.

Acute pharyngitis causes a sore throat. When I was in medical school, we were taught that a patient with a sore throat had either an infection with a type of bacteria called Group A streptococcus (“strep”) or with any of multiple viruses. Group A strep was diagnosed with a throat culture and was treated with antibiotics. Since antibiotics do not work against viral infections, antibiotics were not to be prescribed except when the throat culture showed Group A strep.

The problem was that it wasn’t that simple in practice. One reason was that the results of a culture took one to two days. You had to track down the patient when the culture came back showing Group A strep, and then start treatment. To avoid the time those steps took, many doctors prescribed antibiotics when they were pretty sure the patient had strep.

As a result, antibiotics often were prescribed in people with sore throat caused by viruses. Overuse of antibiotics led to bacteria becoming resistant to antibiotics — which has now become an important problem.

The way a doctor today diagnoses and treats a patient with acute pharyngitis is not very different from the way it was decades ago. One thing that has changed is that 70 years ago, an unrecognized and untreated throat infection with Group A strep could cause one of two serious diseases: acute rheumatic fever or acute glomerulonephritis. Today, however, the Group A strep circulating in the United States are much less likely to cause these diseases.