Clinical Approach to Distinguishing Between Viral and Bacterial Etiologies in Cases of Pharyngitis and Tonsillitis, and Their Management

Abstract

Tonsillitis and pharyngitis are common upper respiratory tract infections, particularly among children. While most cases are self-limiting and viral in origin, the identification of Group A Beta-Hemolytic Streptococcus (GABHS) is crucial for determining the necessity of antibiotic therapy to prevent serious complications such as acute rheumatic fever. This literature review aims to comprehensively discuss the etiology, clinical manifestations, diagnosis, and management of both conditions. The methodology involved a systematic search across databases including PubMed, Google Scholar, ScienceDirect, and StatPearls for relevant literature published between 2015 and 2025. Results indicate that the recommended diagnostic approach involves using clinical scoring systems like the modified Centor score, followed by Rapid Antigen Detection Test (RADT) or throat culture for high-risk patients. Primary management includes supportive therapy for viral infections and first-line penicillin antibiotics for confirmed bacterial cases. In chronic or recurrent conditions, surgical interventions such as tonsillectomy or tonsillotomy have proven effective in improving patient clinical outcomes. In conclusion, accurate diagnosis and rational antibiotic use are essential in clinical management to reduce the public health burden and prevent both suppurative and non-suppurative complications.