What is the treatment for a sore throat?

Treatment of Sore Throat

For sore throat treatment, NSAIDs such as ibuprofen (400 mg every 6-8 hours) are the preferred first-line symptomatic treatment due to their superior analgesic and anti-inflammatory effects compared to acetaminophen. 1, 2

Symptomatic Treatment

First-line options:

• NSAIDs:

  • Ibuprofen 400 mg every 6-8 hours as needed (preferred)
  • Provides better pain relief than acetaminophen, particularly after 2 hours 2
  • Addresses both pain and inflammation

• Acetaminophen:

  • 500-1000 mg every 4-6 hours as needed
  • Alternative for those who cannot take NSAIDs
  • Note: Aspirin should be avoided in children due to risk of Reye syndrome 1

Topical treatments:

• Local anesthetics can provide rapid relief:
  • Lidocaine (8 mg)
  • Benzocaine (8 mg)
  • Ambroxol (20 mg) - best documented benefit-risk profile 3
  • AMC/DCBA throat lozenges (active ingredients in Strepsils) provide rapid analgesic effects lasting up to 2 hours 4

Antibiotic Treatment

Antibiotics should only be used when bacterial infection is strongly suspected or confirmed, particularly group A streptococcal pharyngitis.

When to consider antibiotics:

• Positive rapid strep test or throat culture
• High Centor criteria score (≥3): fever, tonsillar exudates, tender anterior cervical lymphadenopathy, absence of cough 1

Antibiotic options:

1. First-line: Penicillin V

   • Children: 250 mg 2-3 times daily
   • Adults: 500 mg 2-3 times daily
   • Duration: 10 days (complete course is essential) 1

2. Alternative for penicillin allergy:

   • Erythromycin 250-500 mg four times daily for 10 days 5
   • Clindamycin for patients allergic to both penicillin and cephalosporins 1

Treatment Algorithm

1. Assess severity and likely cause:

   • Viral (most common): gradual onset, cough, rhinorrhea, no exudate
   • Bacterial: sudden onset, fever >38°C, tonsillar exudate, cervical lymphadenopathy

2. For all sore throats:

   • Begin with symptomatic treatment (NSAIDs or acetaminophen)
   • Encourage adequate hydration
   • Consider topical treatments for rapid relief

3. For suspected bacterial infection:

   • Perform rapid strep test or throat culture if Centor score ≥2
   • If positive, prescribe appropriate antibiotic
   • Continue symptomatic treatment

Important Considerations

• Antibiotics only modestly reduce duration of symptoms (by about 16 hours) in most cases 6
• Overuse of antibiotics contributes to bacterial resistance
• Non-compliance with 10-day penicillin treatment is a major reason for treatment failure 1
• Tetracyclines, sulfonamides, and trimethoprim-sulfamethoxazole are ineffective for streptococcal pharyngitis 1
• Local antibiotics or antiseptics are not recommended due to lack of efficacy data 3

For most sore throats (viral etiology), symptomatic treatment with NSAIDs and supportive care is sufficient, with antibiotics reserved for confirmed bacterial infections or high-risk patients.