ENT

Pharyngitis

Inflammation of the throat wall causing sore throat and fever; treated with an antibiotic when indicated plus an NSAID and antihistamine.

ICD-10: —
Source: OPD handbook pp.1–6
Status: Draft

Not yet reviewed by a clinician. Check doses and brands against current national guidelines before use.

Symptoms

Fever
Sore throat, itching
Body aches / headache
Vomiting (especially in children)

Diagnosis

Examine vitals of every patient: BP, pulse (tachycardia), respiratory rate, temperature (raised, above 100 °F)
Examine the oral cavity with a tongue depressor: red, inflamed pharyngeal wall, or enlarged tonsils (tonsillitis)
Auscultate the chest
Palpate the abdomen; check for lymphadenopathy

Treatment

Step 1 of 5

1. Antibiotic (choose one)

Choose one antibiotic; cefixime is noted as safe in pregnancy

Prescription

AmoxicillinPenicillin antibiotic

Dose500 mg TDS (1+1+1)

Brand Amoxil

Also sold as Amoxil, Dispermox

Caution: Penicillin allergy

Amoxicillin + Clavulanic acidPenicillin antibiotic + β-lactamase inhibitor

Dose625 mg TDS (1+1+1)

Brand Augmentin / Co-Amoxiclave

Also sold as Augmentin, Co-Amoxiclave, Calamox

Caution: Penicillin allergy; Cholestatic jaundice risk with prolonged use

AzithromycinMacrolide antibiotic

Dose500 mg OD (1+0)

Brand Azitma / Arzomic / Zyto

Also sold as Zithromax, Azomax, Azitma, Arzomic, Zyto, Genthro

Caution: QT prolongation; caution with other QT-prolonging drugs

ClarithromycinMacrolide antibiotic

Dose250 mg BD (1+1)

Brand Klaricid / Rithmo / Pyloclar

Also sold as Klaricid, Rithmo, Pyloclar, Claricid

Cefixime3rd-generation cephalosporin

Dose400 mg OD (1+0)

Brand Caricef / Tixomer

Also sold as Cefspan, Cefim, Caricef, Tixomer, Cefiget

Safe in pregnancy

Rising resistance in Salmonella Typhi; not reliable as a sole agent in XDR typhoid.

Step 2 of 5

2. Fever and pain (NSAID / analgesic)

Paracetamol is safe in pregnancy

Prescription

Paracetamol (Acetaminophen)Analgesic / antipyretic

Dose1 g TDS (2+2+2 of 500 mg)

Brand Panadol / Calpol

Also sold as Panadol, Calpol, Febrol, Pedrol, Calpol 6 Plus (250 mg/5 mL)

Safe in pregnancy

Caution: Do not exceed 4 g/day in adults or 60 mg/kg/day in children; Avoid in severe liver disease

NimesulideNSAID

Dose100 mg BD (1+1)

Brand Nims / Nimusil

Also sold as Nims, Nimusil

IbuprofenNSAID

Dose400 mg TDS

Brand Brufen

Caution: Avoid in dengue (bleeding risk); Avoid in kidney disease, peptic ulcer, late pregnancy; Take with food

DexibuprofenNSAID

Doseas per paediatric table

Brand Tercica

Step 3 of 5

3. Antihistamine

Loratadine is safe in pregnancy and the most economical option per the book (Peritone is listed as the most economical)

Prescription

FexofenadineAntihistamine

Dose60 mg at night (1+0)

Brand Fexet

Also sold as Fexet, Telfast

LoratadineAntihistamine

Dose10 mg at night (1+0)

Brand Jardin

Also sold as Jardin, Softin

Safe in pregnancy

ChlorpheniramineAntihistamine

Dose4 mg at night (1+0)

Brand Peritone

Also sold as Peritone, Piritone

Most economical

Step 4 of 5

4. Supportive care and counselling

Gargle with warm normal saline four times a day
Avoid cold, sour and oily foods

Step 5 of 5

5. Paediatric doses (syrups)

TSF = teaspoonful = 5 mL. TDS = three times a day.

Weight bands in the book: 1 y ≈ 10 kg; 2–5 y ≈ 11–15 kg; over 5 y ≈ 16–20 kg

Prescription

AmoxicillinPenicillin antibiotic

Dose15–30 mg/kg TDS: 1 y, 10 kg → 1 TSF TDS; 2–5 y, 11–15 kg → 1½ TSF TDS; over 5 y, 16–20 kg → 2 TSF TDS

Brand Syp Amoxil 250 mg/5 mL

Also sold as Amoxil, Dispermox

Caution: Penicillin allergy

Paracetamol (Acetaminophen)Analgesic / antipyretic

Dose10–15 mg/kg TDS: 1 y, 10 kg → 1 TSF; 2–5 y, 11–15 kg → 1½ TSF; over 5 y, 16–20 kg → 2 TSF (TDS)

Brand Syp Calpol 120 mg/5 mL

Also sold as Panadol, Calpol, Febrol, Pedrol, Calpol 6 Plus (250 mg/5 mL)

Caution: Do not exceed 4 g/day in adults or 60 mg/kg/day in children; Avoid in severe liver disease

IbuprofenNSAID

Dose10 mg/kg TDS: 1 y, 10 kg → 1 TSF; 2–5 y, 11–15 kg → 1½ TSF; over 5 y, 16–20 kg → 2 TSF (TDS)

Brand Syp Brufen 100 mg/5 mL

Caution: Avoid in dengue (bleeding risk); Avoid in kidney disease, peptic ulcer, late pregnancy; Take with food

Sample prescriptions from the book (patient details removed)

Adult with fever, sore throat, headache and dysphagia for 2 days (T 100 °F, pulse 120): Tab Augmentin 625 mg 1+1+1; Tab Nims 100 mg 1+1; Tab Fexet 60 mg at night; Cap PPI 20 mg before breakfast; gargle warm salt water; avoid cold and oily things.
Child, 14 kg, fever with vomiting: Syp Augmentin 312.5 mg/5 mL 1½ tsf TDS; Syp Brufen 100 mg/5 mL 1½ tsf TDS; Syp Gravinate 1½ tsf if vomiting; Syp Rigix 2.5 mg/5 mL at night.
Pregnant woman, 2nd trimester, fever and sore throat: Cap Caricef 400 mg once daily; Tab Panadol 500 mg if fever; Tab Jardin 10 mg at night.