What is the treatment for a sore throat?

Treatment for Sore Throat

Ibuprofen or paracetamol are recommended as first-line treatments for relieving acute sore throat symptoms. 1, 2

First-Line Treatment Approach

Symptomatic Relief

• Analgesics:
  • Ibuprofen (preferred): More effective than acetaminophen for sore throat pain relief 3
  • Paracetamol (acetaminophen): Alternative if NSAIDs are contraindicated
  • Dosing: Standard adult/pediatric dosing as appropriate for age and weight
  • Avoid aspirin in children due to risk of Reye syndrome 2

When to Consider Antibiotics

Antibiotics should only be considered in specific situations:

1. Assessment using Centor criteria 2:

   • Fever history
   • Absence of cough
   • Tonsillar exudates
   • Tender anterior cervical lymphadenopathy

2. Testing recommendations:

   • 0-1 Centor criteria: No testing or antibiotics needed
   • 2+ Centor criteria: Consider rapid antigen detection test (RADT) or throat culture
   • Testing generally not recommended in children under 3 years 2

3. For confirmed Group A Streptococcal (GAS) infection:

   • First choice: Penicillin V for 10 days 1, 2
     • Children: 250 mg 2-3 times daily
     • Adults: 250 mg 4 times daily or 500 mg twice daily
   • Alternative: Amoxicillin for 10 days 2
     • 50 mg/kg once daily (max 1,000 mg) or 25 mg/kg twice daily (max 500 mg per dose)
   • For penicillin-allergic patients: Cephalexin, clindamycin, azithromycin, or clarithromycin 2, 4

Additional Treatment Options

Topical Treatments

• Local anesthetics (lidocaine, benzocaine, ambroxol) can provide temporary relief 5
• Throat lozenges containing amylmetacresol and dichlorobenzyl alcohol may provide rapid analgesic effects 6
• Flurbiprofen 8.75 mg lozenges can be effective for swollen and inflamed throats 7

Other Considerations

• Corticosteroids are not routinely recommended but may be considered in adult patients with severe presentations (3-4 Centor criteria) 1
• Zinc gluconate is not recommended for sore throat treatment 1
• Herbal treatments and acupuncture have inconsistent evidence and are not generally recommended 1

Important Caveats

• Most sore throats are viral in origin and resolve without antibiotics 8
• Antibiotics should not be used to prevent rheumatic fever or acute glomerulonephritis in low-risk patients 1
• The full 10-day course of antibiotics should be completed when prescribed to prevent complications 2
• Patients should be advised to return if symptoms worsen or fail to improve within 48-72 hours of treatment initiation 2
• Patients with fever and sore throat should be screened for COVID-19 during pandemic periods 2

Special Situations

• Consider tonsillectomy for recurrent episodes (≥7 episodes in past year, ≥5 episodes/year for 2 consecutive years, or ≥3 episodes/year for 3 consecutive years) 2
• For multiple recurrent episodes of GAS pharyngitis, consider clindamycin, amoxicillin-clavulanic acid, or benzathine penicillin G 2