From the Guidelines
For patients with odynophagia (painful swallowing) in acute pharyngitis (sore throat), the most effective treatment option is to start with over-the-counter pain relievers like acetaminophen (Tylenol) 650mg every 6 hours or ibuprofen (Advil, Motrin) 400mg every 6-8 hours to reduce pain and inflammation, as recommended by the American College of Physicians and the Centers for Disease Control and Prevention 1.
Treatment Options
- Over-the-counter pain relievers: acetaminophen (Tylenol) 650mg every 6 hours or ibuprofen (Advil, Motrin) 400mg every 6-8 hours
- Gargling with warm salt water (1/4 to 1/2 teaspoon of salt in 8 ounces of warm water) several times daily to reduce swelling and discomfort
- Throat lozenges or sprays containing benzocaine, menthol, or phenol to temporarily numb the throat; follow package directions for frequency
- Staying hydrated with warm liquids like tea with honey (1-2 teaspoons) to soothe irritated tissues
- Cold foods like popsicles to numb pain
- A humidifier to add moisture to dry air that may be aggravating the throat
- Resting the voice and avoiding irritants like smoking or alcohol
Antibiotic Use
- Antibiotics are usually not needed for sore throats, as most cases are viral and resolve within 5-7 days 1
- However, if symptoms persist beyond a week, or if there is difficulty breathing or swallowing, high fever above 101°F, or a compromised immune system, antibiotics may be needed for bacterial infections like strep throat 1
High-Value Care Advice
- Clinicians should test patients with symptoms suggestive of group A streptococcal pharyngitis by rapid antigen detection test and/or culture for group A Streptococcus, and treat patients with antibiotics only if they have confirmed streptococcal pharyngitis 1
From the FDA Drug Label
Pharyngitis/Tonsillitis In three double-blind controlled studies, conducted in the United States, azithromycin (12 mg/kg once a day for 5 days) was compared to penicillin V (250 mg three times a day for 10 days) in the treatment of pharyngitis due to documented Group A β-hemolytic streptococci (GABHS or S. pyogenes)
The treatment options for odynophagia (painful swallowing) in acute pharyngitis (sore throat) include:
- Azithromycin: 12 mg/kg once a day for 5 days
- Penicillin V: 250 mg three times a day for 10 days 2
From the Research
Treatment Options for Odynophagia in Acute Pharyngitis
The treatment options for odynophagia (painful swallowing) in acute pharyngitis (sore throat) include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen for symptomatic treatment 3, 4, 5, 6
- Acetaminophen for pain relief, although NSAIDs are generally more effective 3, 4
- Antibiotics, such as penicillin, for bacterial pharyngitis, particularly group A beta-hemolytic streptococcal (GAS) pharyngitis 4, 5, 7, 6
- Medicated throat lozenges for pain relief 6
- Corticosteroids, although they provide only a small reduction in the duration of symptoms and are not recommended for routine use 6
Symptomatic Treatment
Symptomatic treatment is recommended for patients with acute pharyngitis, including:
- Ibuprofen and naproxen for pain relief 5
- Self-management and encouragement of patients to manage their symptoms 5
- Use of clinical scores, such as the Centor, McIsaac, and FeverPAIN scores, to assess the risk of bacterial pharyngitis and guide antibiotic treatment 5
Antibiotic Treatment
Antibiotic treatment is recommended for patients with bacterial pharyngitis, particularly GAS pharyngitis, and should be guided by clinical scores and risk assessment 4, 5, 7, 6. Penicillin is the first-line treatment for GAS pharyngitis, with clarithromycin as an alternative 5.