Ibuprofen. Tylenol. +/- antibiotic depending on clinical suspicion for strep.
This works 99% of the time.
Clinical clues to help you find the 1% of cases where this won't work:
- history of receptive oral sex, men who have sex with men: Neisseria gonorrhoeae, treat with ceftriaxone IM, consider concomitant therapy for chlamydia
- unimmunized or underimmunized, foreign travel (especially former Soviet Union), grayish-brown pseudomembrane that involves tonsils and often extends to uvula and soft palate, swelling of the soft tissues of the neck ("bull neck"): Corynebacterium diphtheriae, treat with diphtheria antitoxin and antibiotics (IM pen G or erythromycin)
- HIV risk factors, maculopapular rash, mucocutaneous ulcerations: initial infection with HIV, treatment with antiretroviral is controversial
- Super-ill appearing: abscess, epiglottitis, advanced diphtheriae; these cases aren't so hard to pick up
Source
Alcaide, M. and Bisno, A. "Pharyngitis and Epiglottitis" Infectious Disease Clinics of North America. 2007.
