What is the recommended treatment for a sore throat?

From the Guidelines

For a sore throat, rest, increased fluid intake, and over-the-counter pain relievers like acetaminophen or ibuprofen are recommended. The treatment of sore throat should focus on relieving symptoms, as most cases are viral and resolve within 5-7 days without antibiotics 1.

Recommended Treatment

• Over-the-counter pain relievers like acetaminophen (Tylenol) 325-650mg every 4-6 hours or ibuprofen (Advil, Motrin) 200-400mg every 6-8 hours are recommended for relief of acute sore throat symptoms 1.
• Warm salt water gargles (1/4 to 1/2 teaspoon of salt in 8 ounces of warm water) several times daily can provide relief by reducing inflammation and killing bacteria.
• Throat lozenges containing benzocaine or menthol can temporarily numb the throat and ease pain.
• Honey mixed in warm tea or taken by the teaspoon (1-2 teaspoons as needed) can coat and soothe the throat, though it shouldn't be given to children under one year old.

Antibiotic Use

• Antibiotics should not be used in patients with less severe presentation of sore throat, e.g. 0–2 Centor criteria, to relieve symptoms 1.
• In patients with more severe presentations, e.g. 3–4 Centor criteria, physicians should consider discussion of the likely benefits with patients, as modest benefits of antibiotics have to be weighed against side effects, the effect of antibiotics on the microbiota, increased antibacterial resistance, medicalization and costs 1.
• If antibiotics are indicated, penicillin V, twice or three times daily for 10 days, is recommended 1.

When to Seek Medical Attention

• If symptoms persist beyond a week, are accompanied by fever above 101°F, difficulty swallowing or breathing, or visible white patches on the tonsils, medical attention should be sought as these may indicate strep throat or another bacterial infection requiring antibiotic treatment.
• Staying hydrated helps keep the throat moist and promotes healing, while rest allows the body to direct energy toward fighting infection.

From the FDA Drug Label

Prevention of Initial Attacks of Rheumatic Fever Penicillin is considered by the American Heart Association to be the drug of choice in the prevention of initial attacks of rheumatic fever (treatment of Streptococcus pyogenes infections of the upper respiratory tract e.g., tonsillitis, or pharyngitis). Erythromycin tablets are indicated for the treatment of penicillin-allergic patients. The therapeutic dose should be administered for ten days.

The recommended treatment for a sore throat is penicillin for 10 days for patients with Streptococcus pyogenes infections, as per the American Heart Association. For patients allergic to penicillin, erythromycin is an alternative, also for 10 days 2.

From the Research

Treatment Options for Sore Throat

• Non-steroidal anti-inflammatory drugs (NSAIDs) such as flurbiprofen lozenges have been shown to provide effective relief for sore throat, difficulty swallowing, and swollen throat 3.
• Ibuprofen has been found to be more effective than acetaminophen in relieving sore throat pain, difficulty swallowing, and swollen throat 4.
• Antibiotics are only recommended for sore throats caused by group A beta-hemolytic streptococcal (GABHS) infection, which accounts for 5-15% of sore throats in adults 5, 6.
• Penicillin or amoxicillin are the first-line treatments for GABHS pharyngitis, while patients allergic to penicillin can be treated with first-generation cephalosporins, clindamycin, or macrolide antibiotics 6.

Non-Antibiotic Treatments

• Paracetamol is recommended as first-line treatment for acute sore throat, but its use is often not adhered to due to misconceptions about its effectiveness 7.
• Medicated throat lozenges used every two hours can also provide effective relief for sore throat pain and difficulty swallowing 6.
• Corticosteroids may provide a small reduction in the duration of symptoms, but their use is not recommended as a routine treatment for sore throat 6.

Importance of Proper Diagnosis and Treatment

• A rapid antigen detection test should be ordered in patients with a modified Centor or FeverPAIN score of 2 or 3 to diagnose GABHS pharyngitis 6.
• General practitioners (GPs) play a major role in educating patients about the effective use of paracetamol and other non-antibiotic treatments for sore throat 7.