Depends of the organism.
S. pyogenes: part of life, human to human spread. It can be spread by food leading to outbreaks (PubMed).
Viral: Adenovirus (Pharyngoconjunctival fever), Coronavirus, Coxsackievirus A (Herpangina and hand-foot-and-mouth disease), Cytomegalovirus, Epstein-Barr virus, Herpes simplex virus types 1 and 2, HIV (Primary HIV infection), Influenza A and B viruses, Parainfluenzavirus, Rhinovirus.
Bacteria: S. pyogenes, Group C and G streptococci, Arcanobacterium haemolyticum, Corynebacterium diphtheriae, Francisella tularensis, Mycoplasma pneumoniae, Mixed anaerobes Vincent's angina, N. gonorrhoeae(PubMed), Yersinia enterocolitica, Yersinia pestis.
Penicillin VK, amoxicillin, any oral cephalosporin and any oral macrolides will probably take care of group A streptococcal pharyngitis (IDSA Guidelines). The rest depend on what you grow or suspect from history.
One meta-analysis suggests "There is considerable evidence to suggest that clindamycin and amoxicillin with clavulanate is superior to penicillin" for treatment and preventing relapse (PubMed).
Chlorhexidine gluconate and benzydamine hydrochloride mouth spray, in addition to antibiotic treatment, significantly decreased the intensity pain in patients with streptococcal pharyngitis, although endpoint was the same (PubMed).
Probiotics do nothing for symptoms (PubMed).
Watch for abscesses; will often present as asymmetry of the back of the throat. Prophylaxis of family members to prevent spread doth not work (PubMed). Recurrent disease in adults can be treated by removing the tonsils (PubMed).
- "Acute nonrheumatic streptococcal myocarditis is an under recognized and treatable cause of STsegment elevation and chest pain in young adults with a history of recent pharyngitis (PubMed).
Relevant links to my Medscape blog