Community pharmacy lecture no.4 respiratory system sore throat

Sore throat

Sore throats Any part of the respiratory mucosa of the throat can give rise to symptoms of throat pain. This includes the pharynx (pharyngitis) and tonsils (tonsillitis), Pain can range from scratchiness to severe pain. Sore throats are often associated with the common cold.

Aetiology Viral infection accounts for between 70 and 90 % of all sore throat cases. Remaining cases are nearly all bacterial; The most common cause being Group A beta-haemolytic Streptococcus (also known as Streptococcus pyogenes).

Conditions to eliminate Likely cause Streptococcal sore throat Glandular fever (infectious mononucleosis) Trauma-related sore throat Medicine induced sore throat Laryngeal and tonsillar carcinoma

A. Streptococcal sore throat Patients who present with pharyngeal or tonsillar exudates, swollen anterior cervical glands, high grade fever (over 39.4 c) and absence of cough are more likely to have a bacterial infection. Absolute benefit of antibiotics was modest, with an average reduction in illness time of 1 day. a 10 day course of penicillin or erythromycin (where an allergy to penicillin exists) if the patient has a history of rheumatic fever, increased risk from acute infection, and marked systemic upset.

B.Glandular fever (infectious mononucleosis) Caused by the Epstein-Barr virus called the kissing disease because transmission primarily occurs from saliva. The signs and symptoms of glandular fever can be difficult to distinguish from sore throat because it is characterised by pharyngitis (occasionally with exudates), fever, cervical lymphadenopathy and fatigue.

C.Trauma-related sore throat Occasionally patients develop a sore throat from direct irritation of the pharynx. This can be due to substances such as cigarette smoke, a lodged foreign body or from acid reflux

D. Laryngeal and tonsillar carcinoma Both these cancers have a strong link with smoking and excessive alcohol intake, and are more common in men than women. Sore throat and dysphagia are the common presenting symptoms. Any person, regardless of age, that presents with dysphagia should be referred.

sore throat medicines Local anaesthetics Antibacterial and antifungal agents Anti-inflammatories Analgesia Aspirin and salt water gargles

1. Local anaesthetics (lidocaine, benzocaine) All local anaesthetics have a short duration of action and frequent dosing is required to maintain the anaesthetic effect whether formulated as a lozenge or spray.

2. Antibacterial and antifungal agents Antibacterial agents include chlorhexidine, and benzalkonium chloride. Have antibacterial activity, and some inhibit Candida albicans growth The use of antibacterial and antifungal agents should not be routinely recommended since the vast majority of sore throats are caused by viral infections for which they have no action against. As adverse effects are rare and stimulation of saliva from sucking the lozenge may confer symptomatic relief.

3. Analgesia Paracetamol, aspirin and ibuprofen, are effective in reducing the pain associated with sore throat.

4. Anti-inflammatories (benzydamine and flurbiprofen) Anti-inflammatories have the advantage over local anaesthetics in that they do not generally anaesthetise the entire mouth.

Anti-inflammatories (Benzydamine And Flurbiprofen) BENZYDAMINE Cause stinging (can be diluted with water) FLURBIPROFEN They are contraindicated in patients with peptic ulceration, and must be used with caution in pregnant and breastfeeding women.

5. Aspirin and salt water gargles Gargling with aspirin or salt water is a common remedy for sore throat.