Though more than 80% of acute pharyngitis (AP) cases have a viral etiology, it remains one of the most common causes for the unnecessary prescription of antibiotics (ABs). Half of patients receive antibiotics in general practice. Point-of-Care Tests (POCTs) distinguish between bacterial and viral pharyngitis. The objective of this study was to evaluate the use of POCTs using throat swabs to detect β-Streptococcus pyogenes Group A (strep A) infection among patients with sore throat/acute pharyngitis in primary care practices across Germany. A study was conducted in 1257 primary care practices. Two questionnaires were administered concerning frequency, POCT results and whether antibiotics were prescribed. Of the 1257 physicians, 60% used POCTs. Of these, 25% used a POCT before prescribing an antibiotic, 39% in cases of severe sore throat, 40% in cases of long-lasting pharyngitis and 25% in other cases. In total, 83% considered the adoption of POCTs in everyday practice to be important or very important for the diagnosis of strep A, 90% considered it important or very important for achieving a more sensible use of antibiotics and the prevention of bacterial resistance and 80% considered it important or very important for justifying to patients whether or not an antibiotic is needed. POCT results and information on AB prescriptions were available for 583 patients. Of these, 22.5% tested positive for strep A, and 21.8% were prescribed antibiotics. Our study shows that the use of swab tests in patients with sore throat in primary care practices results in high levels of physician satisfaction and can strongly reduce the misuse of antibiotics in clinical practice.

Too often, antibiotics are prescribed in the treatment of pharyngitis, which can contribute to antimicrobial resistance. We aimed to assess the in vitro antiviral and antimicrobial activity of sugar-free cetylpyridinium chloride (CPC)/benzocaine lozenges, which can potentially offer a more suitable treatment for pharyngitis. The antiviral activity of sugar-free CPC/benzocaine (1.4 mg/10 mg) lozenges (Dolo-Dobendan 1.4 mg/10 mg lozenges) was assessed using the DIN EN 14476:2019-10 suspension test against bovine coronavirus (S379 Reims) or influenza virus A (H1N1/Brisbane/59/2007) under clean and dirty conditions. Viral titers were measured after 1, 5, 10, and 30 min exposure; a reduction of ≥4 lg was considered virucidal. For bovine coronavirus, large volume plating was used due to cytotoxicity. Antimicrobial activity was measured against 11 microorganisms associated with pharyngitis, with contact times of 1, 5, and 10 min (+30 min for positive control). For influenza, sugar-free lozenges showed ≥4 lg efficacy from 5 and 10 min exposure under clean and dirty conditions, respectively. For bovine coronavirus, sugar-free lozenges exhibited ≥4 lg efficacy at 10 min under both conditions. Bactericidal activity was observed against nine of the challenge microorganisms within 5 min, with plate counts of <10 colony-forming units (CFU)/mL for Pseudomonas aeruginosa, Staphylococcus aureus, Arcanobacterium haemolyticum, Moraxella catarrhalis, Porphyromonas gingivalis, Prevotelia intermedia, Streptococcus dysgalactiae, and Streptococcus pyogenes, and <100 CFU/mL for Streptococcus pneumoniae. Candida albicans and Escherichia coli showed counts of <10 CFU/mL at 30 min. Sugar-free CPC/benzocaine lozenges can be recommended for uncomplicated pharyngitis and may be more appropriate than antibiotics, helping to mitigate antimicrobial resistance.

Background: With the rise in off-season patterns of viral infections, approaches to prevent respiratory tract infections and reduce the risk of antibiotic resistance are required. Aims: To determine the in vitro virucidal efficacy of antiseptic cetylpyridinium chloride (CPC) throat lozenges on coronavirus and influenza virus A. Methods: Sugar-containing (SC) and sugar-free (SF) CPC lozenges (Dolo-Dobendan®) were tested with the DIN EN 14476:2019–10 suspension test. Tablets were diluted 80% and incubated with bovine coronavirus (S379 Reims) or influenza virus A (H1N1; Brisbane/59/2007) under clean (0.3g/L bovine serum albumin) or dirty (tripartite soil load according to OECD, to mimic saliva secretion) conditions. A 10-min exposure (equivalent to tablet oral dissolution time) was used to calculate viral titre (TCID50/ml), with a reduction ≥4log10 (≥99.99%) considered sufficient. For coronavirus, large volume plating (LVP) was used as ≥4log10 was not possible due to cytotoxicity. Results: For influenza, after 5mins SC CPC exhibited 98.52% efficacy in clean (1.83±0.58) and dirty (1.83±0.54) conditions, and for SF 4log10 (≥99.99%) in clean (5.17±0.33) and dirty (4.00±0.00) conditions. Using LVP for coronavirus, after 10 mins SC CPC exhibited ≥99.9% efficacy in clean (3.43±0.45) and 99.8% in dirty (2.66±0.47) conditions, and SF CPC exhibited ≥99.99% efficacy in dirty (4.01±0.47) and 99.91% in clean (4.06±0.45) conditions. Conclusion: CPC lozenges demonstrated in vitro virucidal efficacy against coronavirus and influenza virus, which is relevant for the treatment of viral mouth and throat infections, and may be used as a preventative oral hygiene measure to reduce viral transmission risk.

Acute respiratory infections (ARIs) are among the most common infectious diseases worldwide and represent a substantial clinical and socioeconomic burden. Despite their predominantly viral aetiology, inappropriate antibiotic prescribing remains common, highlighting the need for effective non-antibiotic treatment strategies. In this narrative review, we summarize the pharmacological properties and potential clinical relevance of Plantago lanceolata and Sisymbrium officinale in the symptomatic management of uncomplicated upper airway infections. A narrative literature search of PubMed/MEDLINE, Google Scholar, and the herbal monographs and assessment reports of the European Medicines Agency was conducted, focusing on experimental, clinical, and real-world evidence related to symptom relief, anti-inflammatory effects, and cough modulation. Emphasis was placed on recent in vitro studies investigating epithelial inflammatory responses and cough-related signalling pathways. In cell-based experimental models, both extracts reduced key inflammatory mediators, including prostaglandin E₂, tumour necrosis factor-α, and interleukin-6, in human tonsil epithelial cells stimulated with bacterial cell wall components. In addition, both plant extracts attenuated bradykinin-induced intracellular calcium signalling in bronchial epithelial cells, which is consistent with, but does not demonstrate, modulation of cough-related pathways. These in vitro findings provide a biological rationale for their traditional use in relieving sore throat, irritation, and cough, but they are not direct evidence of clinical efficacy, and clinical trials of these two extracts are lacking. Given the central role of symptom burden in driving healthcare utilization and antibiotic-seeking behaviour, effective symptomatic therapies are important. Whether herbal medicinal products with anti-inflammatory and cough-modulating properties improve symptom control and thereby support antimicrobial stewardship remains to be demonstrated. Future research should include randomized controlled trials with validated symptom outcomes and real-world studies evaluating the impact of these extracts on antibiotic prescribing in clinical practice.