Most patients that walk into a doctor’s office with a
Infection or Not
Many falsely assume that pain in their throat means they have an infection (or pharyngitis). This is not necessarily the case as there are multiple non-infectious reasons to have a
Bacterial vs. Viral
After I decide that a patient has pharyngitis, then the next step is to determine if a bacteria or virus is to blame. Bacterial infection (more commonly called strep throat) would warrant antibiotics while viral infection calls for rest, fluids, salt gargles, and symptomatic treatment like Tylenol. Fortunately, criteria have been developed to help make this determination, termed the Centor criteria. These are named for the investigator that developed the criteria (original article here). The criteria are as follows:
Temperature greater than 100.4 degrees Fahrenheit
Tonsillar exudates (plaques that can be seen on the tonsils)
Tender, enlarged neck lymph nodes
No cough present
If one or no criteria are present, then it is likely viral. If two or three are present, then the patient should undergo a rapid strep test to determine if antibiotics are needed. If all four criteria are present, then the patient can simply be treated with antibiotics.
Believe it or not, it is that simple in many cases. With this information in hand, you should be much better equipped to have a good conversation with your doctor about your illness. Try not to smile too much when your doctor starts to go over this information with you. He doesn’t know that you’re already an expert!