If the physical examination is well done, the correct diagnosis will follow. It is the hurried physician with a weak light and an uncooperative patient who misdiagnoses and mistreats. Acute Sore Throat 2 is the controversial algorithm. Given the large number of patients presenting with sore throat, cumulatively these tests are very expensive. It is therefore our recommendation that those pharyngitides which behave like a viral infection, be treated as such.
Antibiotics play no role in their treatment and are a wasted health care dollar.
They place the patient at unnecessary risk of allergic reaction to the antibiotics and expose an incredible number of normal oral organisms to antibiotics thereby promoting resistant organisms both in the patient and in the world. While it may be true that it is easier to prescribe an antibiotic than to explain why you should not prescribe an antibiotic, most knowledgeable physicians will agree that antibiotics are not indicated for viral pharyngitis. If a viral pharyngitis diagnosis is made, and in fact, the patient has tonsillitis, the fever and the sore throat will continue and the patient will return on the second or third infectious day. The correct diagnosis will then be made. While the patient may have suffered an extra day or two of morbidity, no other harm has been done.