What is the recommended treatment for a sore throat?

Treatment of Acute Sore Throat

For acute sore throat, ibuprofen or paracetamol (acetaminophen) are recommended as first-line treatment for symptom relief, with ibuprofen showing a better benefit-risk profile for pain management. 1, 2

Treatment Algorithm for Sore Throat

Step 1: Symptomatic Treatment

• First-line medications:
  • Ibuprofen (preferred): 400mg every 6-8 hours as needed 1, 3
  • Paracetamol (acetaminophen): 500-1000mg every 4-6 hours as needed 1

Step 2: Assess Need for Antibiotics

• Use Centor Criteria to determine likelihood of Group A Streptococcal (GAS) pharyngitis 4:

  • Fever >38°C
  • Absence of cough
  • Tonsillar exudates
  • Tender anterior cervical lymphadenopathy

• Score interpretation:

  • 0-1: No testing or antibiotics needed
  • ≥2: Perform rapid antigen detection test or throat culture 4, 5

Step 3: Antibiotic Treatment (if GAS confirmed)

• First-line: Penicillin V 500mg 2-3 times daily for 10 days (adults) 4
• Alternative: Amoxicillin 50mg/kg once daily (maximum 1000mg) for 10 days 4
• For penicillin allergy:
  • Cephalexin: 20mg/kg twice daily (maximum 500mg per dose) for 10 days
  • Clindamycin: 7mg/kg three times daily (maximum 300mg per dose) for 10 days
  • Azithromycin: 12mg/kg once daily (maximum 500mg) for 5 days 4, 6

Additional Therapeutic Considerations

Corticosteroids

• Not routinely recommended
• May be considered in adult patients with severe presentations (3-4 Centor criteria) in conjunction with antibiotic therapy 1, 5

Local Anesthetics

• Can provide temporary relief for sore throat pain 2
• Options include lozenges containing:
  • Lidocaine (8mg)
  • Benzocaine (8mg)
  • Ambroxol (20mg)

Not Recommended Treatments

• Zinc gluconate (not recommended due to conflicting results and adverse effects) 1
• Herbal treatments and acupuncture (inconsistent evidence) 1
• Local antibiotics or antiseptics (lack of efficacy data) 2

Important Clinical Considerations

• Patients with GAS pharyngitis are considered non-contagious after 24 hours of antibiotic therapy 4
• Symptoms typically improve within 24-48 hours after starting appropriate treatment 4
• Routine follow-up testing is not recommended for asymptomatic patients after completing treatment 4
• For patients with recurrence shortly after treatment completion, consider retreatment with the same antibiotic or intramuscular benzathine penicillin G 4

Common Pitfalls to Avoid

1. Overuse of antibiotics: Only 5-15% of adult and 15-30% of pediatric sore throats are caused by GAS and require antibiotics 5
2. Inadequate pain management: Pain relief is essential for patient comfort and should be addressed promptly
3. Inappropriate corticosteroid use: Reserve for severe cases only, not routine use 1
4. Insufficient antibiotic duration: Complete the full 10-day course of penicillin/amoxicillin to prevent complications like acute rheumatic fever 4
5. Using aspirin in children: Avoid due to risk of Reye syndrome 4

By following this evidence-based approach, most cases of sore throat can be effectively managed with appropriate symptom relief and targeted antibiotic therapy when indicated.