What is the treatment for a sore throat?

Treatment of Sore Throat

For most cases of sore throat, symptomatic treatment with NSAIDs (particularly ibuprofen) or paracetamol is recommended as first-line therapy, with antibiotics reserved only for cases with high likelihood of streptococcal infection (3-4 Centor criteria) and positive testing. 1, 2

Diagnosis and Assessment

Before determining treatment, assess the likelihood of streptococcal infection using the Centor criteria:

• Fever by history
• Tonsillar exudates
• Tender anterior cervical adenopathy
• Absence of cough

Additional considerations:

• Clinical features suggesting viral etiology (cough, rhinorrhea, hoarseness, oral ulcers) make streptococcal infection less likely 1
• Patients with 0-2 Centor criteria are unlikely to have streptococcal infection and don't require testing 1
• Patients with 3-4 Centor criteria should be tested with rapid antigen detection test (RADT) 1, 2

First-Line Treatment

Symptomatic Treatment

• NSAIDs (particularly ibuprofen) provide better pain relief than acetaminophen in most studies 1, 3
• Acetaminophen (paracetamol) is an effective alternative 2, 1
• Additional symptomatic measures:
  • Warm salt water gargles
  • Throat lozenges (local anesthetics like benzocaine, lidocaine, or ambroxol may provide relief) 4

Antibiotic Treatment

Antibiotics should be considered only when:

1. Clinical features strongly suggest streptococcal infection (3-4 Centor criteria)
2. Testing is positive for Group A Streptococcus

When antibiotics are indicated:

• First choice: Penicillin V (500 mg orally 2-3 times daily for 10 days) 2, 1
• Alternative: Amoxicillin (50 mg/kg once daily, maximum 1000 mg, for 10 days) 1, 5

For patients with penicillin allergy:

• Non-anaphylactic allergy: Cephalexin (20 mg/kg twice daily, maximum 500 mg per dose, for 10 days) 1
• Immediate hypersensitivity/anaphylactic allergy: Clindamycin, azithromycin, or clarithromycin 1

Important Considerations

When to Use Antibiotics

• Antibiotics should not be used in patients with less severe presentation (0-2 Centor criteria) 2, 1
• Benefits of antibiotics must be weighed against side effects, impact on microbiota, antibiotic resistance, and costs 2
• Antibiotics can reduce the risk of complications such as acute otitis media and quinsy (peritonsillar abscess) 6
• A full 10-day course of antibiotics is critical to prevent rheumatic fever, even if symptoms resolve earlier 1

When to Seek Further Medical Attention

• If sore throat symptoms do not improve within 7 days 7
• If irritation, pain, or redness persists or worsens 7
• If swelling, rash, or fever develops 7

Pitfalls and Caveats

1. Overuse of antibiotics: Most sore throats are viral in origin and do not require antibiotics 8, 6
2. Incomplete antibiotic course: Failure to complete the full 10-day course may lead to treatment failure and risk of rheumatic fever 1
3. Misdiagnosis: Clinical scoring systems and rapid tests should be used to target antibiotic use appropriately 2
4. Inappropriate use of local antibiotics or antiseptics: These should not be recommended due to lack of efficacy data 4

Remember that patients are considered non-contagious after 24 hours of appropriate antibiotic therapy if a bacterial infection is being treated 1.