急性咽頭炎：概要と管理

Acute pharyngitis stems from infectious and non-infectious causes. Infectious causes include viral infections like rhinovirus, bacterial infections such as Group A Streptococcus (strep throat), and fungal infections like candida albicans. Non-infectious causes include allergen exposure, dry air, smoking, pollution, and gastric reflux. Accurate diagnosis determines the underlying cause and guides appropriate treatment.

Acute pharyngitis is diagnosed using rapid antigen detection testing (RADT), which involves swabbing the posterior pharynx and tonsils to identify strep bacteria quickly. If RADT is negative but symptoms persist, a throat culture is performed to confirm diagnosis. A throat culture is more sensitive and allows bacteria to grow in the laboratory over several days, accurately detecting strep bacteria even when rapid tests are negative.

Primary symptoms include a painful sore throat, fever, and anterior cervical lymph node enlargement. Additional manifestations include tonsillar or pharyngeal exudate, headache, myalgia, hoarse voice, cough, and runny nose. Candida infections present with white, irregular patches on the oropharynx. Symptoms vary depending on whether the infection is viral, bacterial, or fungal in origin.

Bacterial pharyngitis requires a complete course of antibiotics to prevent complications. Penicillin V potassium is the preferred treatment, typically prescribed as a 10-day oral regimen. For penicillin-allergic patients, alternatives include erythromycin, clarithromycin, or azithromycin. Penicillin injections are reserved for patients with adherence concerns. Tonsillitis management follows similar antibiotic protocols when bacterial infection affects the tonsils.

Viral pharyngitis treatment focuses on symptom relief through analgesics like acetaminophen taken every 4 to 6 hours, benzocaine gargles, and cool-mist humidifiers. Rest, warm liquids, throat lozenges, and cool beverages provide comfort. In severe cases, acetaminophen with codeine offers stronger pain control. These supportive measures alleviate discomfort while the immune system clears the viral infection naturally.

Fungal pharyngitis, typically caused by candida albicans, is treated with antifungal agents such as nystatin. Fungal infections often develop following prolonged antibiotic use or inhaled corticosteroid therapy and are more common in immunosuppressed individuals, particularly those with HIV infections. Antifungal therapy eliminates the infection and prevents recurrence in susceptible populations.

Nutritional therapy focuses on comfortable swallowing and adequate hydration. A soft or liquid diet is recommended with choices based on patient preference, including cool beverages, warm liquids, and flavored frozen desserts like ice pops to alleviate throat discomfort. Patients should consume at least 2 to 3 liters of fluid daily. In severe cases where soreness prevents oral intake, intravenous fluids may be necessary.