What is the treatment for viral sore throat?

Treatment for Viral Sore Throat

The primary treatment for viral sore throat is symptomatic relief with analgesics such as ibuprofen or paracetamol, as antibiotics are not effective against viral infections and should be avoided in patients with less severe presentations (0-2 Centor criteria). 1

Diagnosis and Assessment

Before initiating treatment, it's important to determine if the sore throat is viral or bacterial:

• Viral sore throat indicators:

  • Presence of cold symptoms (cough, rhinorrhea)
  • Conjunctivitis
  • Absence of fever or lower-grade fever
  • Absence of tonsillar exudate
  • Absence of tender cervical lymphadenopathy

• Bacterial indicators (Centor criteria):

  • Fever >38.5°C
  • Tonsillar exudate
  • Tender anterior cervical lymphadenopathy
  • Absence of cough

Most cases of sore throat (70-85%) are viral in origin, with rhinovirus being the most common causative agent 2, 3.

First-Line Treatment for Viral Sore Throat

Analgesics/Antipyretics

• Ibuprofen: Recommended as first-line due to superior efficacy

  • Adults: 400mg every 6-8 hours (maximum 1200mg/day)
  • Children: 5-10mg/kg every 6-8 hours 1, 4

• Paracetamol (Acetaminophen): Alternative option

  • Adults: 500-1000mg every 4-6 hours (maximum 4000mg/day)
  • Children: 10-15mg/kg every 4-6 hours 1, 4

Both ibuprofen and paracetamol have been shown to be more effective than placebo for reducing acute sore throat symptoms, with ibuprofen showing slightly better pain relief 1.

Hydration

• Maintain adequate fluid intake to prevent dehydration and keep the throat moist 4

Local Anesthetics

• Lidocaine (8mg), benzocaine (8mg), or ambroxol (20mg) lozenges can provide temporary relief 5

When to Consider Additional Treatments

Corticosteroids

• Not routinely recommended for viral sore throat
• May be considered in adult patients with severe symptoms (3-4 Centor criteria) in conjunction with other treatments 1, 4

Treatments to Avoid

• Antibiotics: Should not be used for viral sore throat as they:

  • Provide no benefit against viral infections
  • Contribute to antibiotic resistance
  • Can cause side effects
  • Alter normal microbiota
  • Increase healthcare costs 1

• Zinc gluconate: Not recommended due to insufficient evidence of benefit 1

• Herbal treatments and acupuncture: Inconsistent evidence supporting their use 1

Duration and Follow-up

Most viral sore throats resolve within 7-10 days without specific treatment. If symptoms persist beyond 7 days or worsen after 48-72 hours of symptomatic treatment, reassessment is warranted to rule out bacterial superinfection or complications 4.

Prevention

• Hand hygiene
• Avoiding close contact with infected individuals
• Not sharing utensils or drinks 4

Important Caveats

• Children under 3 years: Focus on age-appropriate symptomatic relief 4
• Avoid aspirin in children due to risk of Reye syndrome 4
• If symptoms worsen significantly or persist beyond 7 days, consider bacterial superinfection or complications

The evidence strongly supports that viral sore throat is best managed with symptomatic treatment focusing on pain relief and hydration, while avoiding unnecessary antibiotics that provide no benefit and may cause harm 1, 4.