What is the recommended treatment for a sore throat?

Treatment for Sore Throat

For acute sore throat, either ibuprofen or paracetamol (acetaminophen) are recommended as first-line treatment for symptom relief, while antibiotics should only be considered for patients with high likelihood of streptococcal infection (3-4 Centor criteria). 1

Diagnostic Approach

Before determining treatment, assess the likelihood of bacterial infection using clinical scoring systems:

• The Centor clinical scoring system helps identify patients with higher likelihood of group A streptococcal infection 1
• Criteria include: fever, absence of cough, tonsillar exudates, and tender anterior cervical lymphadenopathy 2
• In patients with high likelihood of streptococcal infections (3-4 Centor criteria), consider using rapid antigen tests (RATs) 1
• For patients with lower likelihood (0-2 Centor criteria), RATs are not routinely needed 1

First-Line Treatment: Symptomatic Relief

Analgesics

• Either ibuprofen or paracetamol (acetaminophen) are recommended for relief of acute sore throat symptoms 1
• Evidence suggests ibuprofen may have the best benefit-risk profile among available analgesics 3
• NSAIDs (like ibuprofen and naproxen) are more effective than acetaminophen for treating fever and pain associated with sore throat 4, 2

Local Treatments

• Medicated throat lozenges used every two hours can provide effective symptom relief 2
• Local anesthetics with confirmed efficacy include lidocaine (8mg), benzocaine (8mg), and ambroxol (20mg) 3
• Ambroxol lozenges (20mg) have shown efficacy and safety in randomized controlled trials for acute uncomplicated sore throat 5

Antibiotic Treatment

When to Use Antibiotics

• Antibiotics should NOT be used in patients with less severe presentation (0-2 Centor criteria) 1
• For patients with 3-4 Centor criteria, modest benefits of antibiotics must be weighed against side effects, impact on microbiota, increased resistance, and costs 1
• The prevention of suppurative complications is not a specific indication for antibiotic therapy 1
• Sore throat should not be treated with antibiotics to prevent rheumatic fever in low-risk patients 1

Choice of Antibiotic

• If antibiotics are indicated, penicillin V twice or three times daily for 10 days is the recommended first choice 1
• For patients allergic to penicillin, alternatives include first-generation cephalosporins, clindamycin, or macrolide antibiotics 2
• For poor patient compliance, benzathine penicillin G can be administered parenterally in a single dose 6
• Current evidence does not support shorter treatment durations 1

Other Treatment Options

Corticosteroids

• Corticosteroids are not routinely recommended for treatment of sore throat 1
• They can be considered in adult patients with more severe presentations (3-4 Centor criteria) in conjunction with antibiotic therapy 1
• Corticosteroids provide only a small reduction in symptom duration and should not be used routinely 2

Treatments Not Recommended

• Zinc gluconate is not recommended for use in sore throat due to conflicting results and increased adverse effects 1
• Local antibiotics or antiseptics should not be recommended due to the mainly viral origin of sore throat and lack of efficacy data 3
• There is inconsistent evidence for herbal treatments and acupuncture as treatments for sore throat 1

Special Considerations

• Most cases of acute sore throat are self-limiting with a mean duration of 7 days 4
• For streptococcal pharyngitis, a 10-day course of penicillin or amoxicillin is necessary to prevent complications like rheumatic fever 7, 2
• Delayed antibiotic prescribing (waiting >48 hours) is a valid option for patients with intermediate risk 1
• Patients should be encouraged in self-management of symptoms 4