What topical spray is recommended for pharyngitis (sore throat)?

From the Guidelines

For a sore throat spray, I recommend Chloraseptic or Cepacol phenol-based sprays, which provide quick numbing relief for throat pain. These over-the-counter options contain local anesthetics like phenol or benzocaine that temporarily numb throat tissues. Use as directed on the package, typically 3-4 sprays directly to the back of the throat every 2 hours as needed, not exceeding 12 doses in 24 hours.

Key Considerations

• Alternatively, consider sprays with natural ingredients like honey, propolis, or saltwater if you prefer non-medicated options 1.
• These sprays work by coating irritated throat tissues and reducing inflammation.
• The numbing effect is temporary (15-30 minutes), so you may need to reapply throughout the day.
• If your sore throat persists beyond 7 days, is accompanied by high fever, or causes difficulty breathing or swallowing, consult a healthcare provider as these symptoms may indicate a more serious condition requiring different treatment.

Treatment Approach

• The European Society for Clinical Microbiology and Infectious Diseases established the Sore Throat Guideline Group to write an updated guideline to diagnose and treat patients with acute sore throat 1.
• In diagnosis, Centor clinical scoring system or rapid antigen test can be helpful in targeting antibiotic use.
• To treat sore throat, either ibuprofen or paracetamol are recommended for relief of acute sore throat symptoms 1.
• Zinc gluconate is not recommended to be used in sore throat 1.
• There is inconsistent evidence of herbal treatments and acupuncture as treatments for sore throat 1.
• Antibiotics should not be used in patients with less severe presentation of sore throat, e.g. 0–2 Centor criteria to relieve symptoms 1.
• Modest benefits of antibiotics, which have been observed in patients with 3–4 Centor criteria, have to be weighed against side effects, the effect of antibiotics on microbiota, increased antibacterial resistance, medicalisation and costs 1.

From the FDA Drug Label

Directions Adults and children 2 years of age and older: apply to affected area using applicator tip use up to 4 times daily or as directed by a dentist or doctor children under 12 years of age should be supervised in the use of this product children under 2 years of age: consult a dentist or doctor

• Benzocaine (TOP) spray can be ordered for sore throat.
• The recommended usage is to apply to the affected area using the applicator tip.
• The spray can be used up to 4 times daily or as directed by a dentist or doctor 2.

From the Research

Spray Options for Sore Throat

• Benzocaine lozenges have been shown to be effective in reducing pain associated with sore throat 3
• Cetylpyridinium chloride (CPC) and benzocaine lozenges have been found to have bactericidal and virucidal action against common oropharyngeal pathogens, making them a potential treatment option for pharyngitis 4
• Dexamethasone has been shown to be effective as an adjuvant therapy for acute pharyngitis, providing significant relief of pain 5

Key Considerations

• The use of antibiotics should be exercised with restraint, as they are not always necessary for the treatment of pharyngitis and can contribute to antimicrobial resistance 6
• A thorough history and clinical findings are key to diagnosing pharyngitis and providing targeted treatment 6
• Rapid antigen detection tests and throat cultures can be used to identify the inciting organism and guide treatment 6

Treatment Options

• Aspirin or nonsteroidal anti-inflammatory agents (NSAIAs) can be used to treat pain associated with pharyngitis 7
• Penicillin remains the antibiotic of choice for group A beta-hemolytic streptococcal (GAS) pharyngitis 7
• Benzocaine lozenges and CPC/benzocaine lozenges can be used as a symptomatic treatment for acute sore throat 3, 4