Sore-Throat-Clinical-Overview-and-Management.pptx

Community Pharmacy

1. Sore Throat Shabaz Ahmed

2. Clinical Overview and Management Sore throat represents inflammation of any part of the respiratory mucosa of the throat, including the pharynx (pharyngitis) and tonsils (tonsillitis). The condition ranges from mild irritation to severe pain and is one of the most common presenting symptoms in community pharmacy settings.

3. Epidemiology In the UK, a general practitioner with 2000 patients typically sees approximately 120 people annually with throat infections. However, four to six times as many people visit pharmacies for self-treatment. Adults experience an average of two to three sore throats each year.

4. Etiology - Viral Infections Viral infections account for 70-90% of all sore throat cases. These cases are typically self-limiting and resolve within one week. Viral causes include: Rhinovirus Coronavirus Epstein-Barr virus (causing glandular fever)

5. Etiology - Bacterial Infections Bacterial infections comprise 10-20% of cases. The primary bacterial cause is Group A beta- haemolytic Streptococcus (Streptococcus pyogenes). These cases may require antibiotic treatment, though many resolve without intervention.

6. Pathophysiology - Inflammation Process The underlying mechanism involves Inflammation of the pharyngeal mucosa Local immune response activation Release of inflammatory mediators Development of mucosal edema Increased nerve sensitivity in the affected area

7. Pathophysiology - Clinical Manifestations The inflammatory process results in: Pain and discomfort Difficulty swallowing Local redness and swelling Possible exudate formation Cervical lymph node enlargement

8. Patient Assessment - Clinical Features Key features to evaluate: Severity and nature of throat pain Presence and degree of difficulty swallowing Fever occurrence and magnitude Cervical lymph node status Presence of tonsillar exudates Associated symptoms

9. Patient Assessment - Physical Examination Proper examination technique: Position patient at eye level Use adequate lighting (pen torch) Ask patient to say "ah" Examine tonsils for size, redness, and exudates Check posterior pharyngeal wall Assess cervical lymph nodes

10. Asking Questions - Age Considerations Age-related patterns: Streptococcal infection uncommon in children under 3 years Higher prevalence in school-age children (5-10 years) Common in young adults (15-25 years) Glandular fever most prevalent in adolescents

11. Asking Questions - Key Clinical Queries Essential questions for assessment: Duration of symptoms Presence of tender cervical glands Existence of tonsillar exudate History of fever Associated symptoms Previous treatments attempted

12. Asking Questions - Red Flags Critical symptoms requiring immediate referral: Duration exceeding 2 weeks Significant difficulty breathing Inability to swallow liquids Persistent high fever (>38.5°C) Voice changes Unilateral swelling

13. Treatment - General Approach Treatment principles: Most cases are self-limiting Focus on symptom relief Consider both local and systemic treatments Regular medication more effective than as-needed Patient education crucial

14. Treatment : Local Anesthetics Local anesthetic options: Lidocaine (various strengths) Benzocaine preparations Short duration of action Frequent dosing required Generally safe in pregnancy and breastfeeding

15. Treatment : Anti-inflammatory Agents Anti-inflammatory options: Benzydamine (rinse, spray, lozenge) Flurbiprofen lozenges Evidence supports effectiveness Different formulations for various age groups

16. Treatment - Systemic Analgesics Systemic pain relief: Paracetamol Ibuprofen Aspirin (adults only) Regular dosing more effective than as-needed Good evidence base for effectiveness

17. Treatment - Additional Measures Supportive care: Adequate hydration Rest Warm saltwater gargles Avoiding irritants Proper nutrition

18. Contraindications - Local Anesthetics Contraindications for local anesthetics: Known hypersensitivity Children under specified age limits Open wounds or lesions Severe gag reflex History of adverse reactions

19. Contraindications - Anti-inflammatory Agents Contraindications for NSAIDs: Active peptic ulceration Severe renal impairment Third trimester pregnancy Known NSAID sensitivity History of gastrointestinal bleeding

20. Patient Counseling - Duration and Course Educate patients about: Expected duration (40% symptom-free after 3 days) Natural course of illness Normal progression of symptoms When to expect improvement Signs of complications

21. Patient Counseling - Self-Care Measures Advise patients on: Proper medication use and timing Adequate fluid intake Rest requirements Avoiding triggers Prevention strategies

22. Patient Counseling - Warning Signs Instruct patients to seek medical attention for: Symptoms persisting beyond 7 days Development of severe symptoms Appearance of red flags Lack of improvement with treatment New or worsening symptoms

23. Patient Counseling - Prevention Prevention strategies: Good hand hygiene Avoiding close contact when infectious Not sharing personal items Maintaining general health Avoiding known triggers

24. THANK YOU! QUESTIONS?