What is the treatment for a sore throat?

Treatment for Sore Throat

For most sore throats, symptomatic treatment with analgesics/antipyretics such as acetaminophen or NSAIDs is recommended as first-line therapy, as most cases (80-90%) are viral in origin and do not require antibiotics. 1

Diagnosis Approach

Before determining treatment, assess for bacterial vs. viral cause using:

• Centor Criteria to evaluate likelihood of streptococcal pharyngitis 1:

  • Tonsillar exudates
  • Tender anterior cervical lymph nodes
  • Lack of cough
  • Fever

• Patients with 0-2 Centor criteria likely have viral pharyngitis and need only symptomatic treatment

• Patients with 3-4 criteria should be tested with rapid antigen detection test (RADT) and/or throat culture 1

Treatment Algorithm

For Viral Sore Throat (Most Common)

1. First-line symptomatic treatment:

   • Acetaminophen or NSAIDs (ibuprofen) for pain and fever relief 1, 2
   • Ibuprofen may have the best benefit-risk profile among analgesics 2
   • Avoid aspirin in children due to risk of Reye's syndrome 1

2. Supportive measures:

   • Cold liquids or ice chips
   • Gargling with cold water
   • Avoiding hot liquids and spicy foods that may irritate the throat 1

3. Topical options (if needed for additional relief):

   • Local anesthetics with documented efficacy: lidocaine (8mg), benzocaine (8mg), or ambroxol (20mg) lozenges 2
   • Flurbiprofen 8.75mg lozenges can provide relief for swollen and inflamed throats 3

For Bacterial Sore Throat (Group A Streptococcal)

If confirmed by testing or strongly suspected based on clinical criteria:

1. First-line antibiotic:

   • Penicillin V or amoxicillin for 10 days 1, 4
   • For children: amoxicillin preferred (50 mg/kg once daily, maximum 1000 mg; or 25 mg/kg twice daily, maximum 500 mg per dose) 1, 4
   • For adults: 500 mg 2-3 times daily 4

2. For penicillin allergy (non-anaphylactic):

   • First-generation cephalosporins for 10 days 1

3. For anaphylactic penicillin allergy:

   • Clindamycin (300-450 mg three times daily)
   • Clarithromycin or azithromycin (12 mg/kg once daily, max 500 mg, for 5 days) 1

Important Considerations

• Complete the full 10-day course of antibiotics for streptococcal pharyngitis, even if symptoms improve, to prevent acute rheumatic fever 1, 4

• Patients should complete at least 24 hours of antibiotics before returning to school or work to reduce transmission risk 1

• Antibiotics should be used only when bacterial infection is confirmed or strongly suspected, as overuse contributes to antibiotic resistance 1, 5

• Antibiotics do reduce the risk of complications like acute otitis media and peritonsillar abscess (quinsy), but these are relatively uncommon 6

When to Seek Further Medical Care

• Severe difficulty swallowing or breathing
• Inability to swallow liquids
• Drooling or voice changes
• Neck stiffness
• Rash
• Symptoms persisting beyond 7 days or worsening after initial improvement

Most sore throats are self-limiting and will resolve within 7 days with or without treatment, with 82% of patients being symptom-free by one week even without antibiotics 6.