What medications are used to treat a sore throat?

Medications for Sore Throat Treatment

For symptomatic relief of sore throat, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are recommended as first-line treatment due to their superior efficacy in reducing pain and inflammation compared to other analgesics. 1

First-Line Symptomatic Treatments

Analgesics/Anti-inflammatory Medications

• Ibuprofen:

  • Recommended as first choice due to best benefit-risk profile
  • Dosage: Adults - 400mg every 6-8 hours as needed
  • More effective than acetaminophen for pain relief after 2 hours 2
  • As safe as acetaminophen for short-term treatment 1

• Acetaminophen/Paracetamol:

  • Effective alternative for those who cannot take NSAIDs
  • Dosage: Adults - 500-1000mg every 4-6 hours (maximum 4g daily)

• Other NSAIDs:

  • Naproxen: Effective alternative to ibuprofen 3
  • Diclofenac: Slightly more effective than acetaminophen 1
  • Avoid aspirin in children due to risk of Reye's syndrome

Topical Treatments

• Local anesthetics:
  • Lidocaine (8mg)
  • Benzocaine (8mg)
  • Ambroxol (20mg) - best documented benefit-risk profile 4
  • Available as lozenges, sprays, or gargles
  • Provide temporary relief by numbing throat tissue

When to Consider Antibiotics

Antibiotics should only be prescribed when bacterial infection is likely:

1. Use clinical scoring systems to assess likelihood of bacterial pharyngitis:

   • Centor criteria or McIsaac score 5
   • Score of 0-2: No antibiotics needed
   • Score of 3: Consider delayed prescription
   • Score of 4+: Consider immediate antibiotics

2. First-line antibiotics (only if bacterial infection suspected):

   • Penicillin V: 250mg three times daily or 500mg twice daily for 10 days 5
   • Amoxicillin: 50mg/kg once daily (max 1000mg) or 25mg/kg twice daily (max 500mg per dose) for 10 days 5, 6

3. For penicillin-allergic patients:

   • Azithromycin: 12mg/kg once daily (max 500mg) for 5 days 5, 7
   • Clindamycin: 300-450mg three times daily for 10 days 5

Important Considerations

• Most sore throats are viral and self-limiting, resolving within 7 days 3
• Benefits of antibiotics are modest: Only 1-2 days reduction in symptoms even in bacterial cases 8
• Antibiotic risks: Side effects, impact on microbiota, increased resistance 5
• Antibiotics reduce complications: Acute otitis media, quinsy, and rheumatic fever, though these are rare in developed countries 8
• Local antibiotics or antiseptics should not be recommended due to lack of efficacy data 4

Treatment Algorithm

1. Assess severity and red flags:

   • Severe systemic symptoms, immunocompromise, or difficulty breathing require urgent evaluation
   • Absence of red flags → proceed with symptomatic treatment

2. First-line approach:

   • Start with ibuprofen or other NSAID for pain relief
   • Add local anesthetic lozenges/sprays for additional relief
   • Encourage adequate hydration and rest

3. If bacterial infection suspected (3-4 Centor criteria):

   • Consider rapid antigen detection test if available
   • Positive test → prescribe appropriate antibiotic
   • Negative test → continue symptomatic treatment only

Remember that most sore throats will resolve without antibiotics, and symptomatic treatment with NSAIDs and local anesthetics is usually sufficient to manage discomfort while the condition resolves naturally.