What is the best treatment for pharyngitis (sore throat)?

From the Guidelines

The most effective treatment for pharyngitis (sore throat) is to use analgesics such as ibuprofen or paracetamol for relief of symptoms, and to consider antibiotics only in cases of confirmed streptococcal pharyngitis, as most cases are viral and will resolve on their own within 5-7 days. For mild to moderate sore throats, over-the-counter pain relievers like acetaminophen (Tylenol) at 650mg every 6 hours or ibuprofen (Advil, Motrin) at 400mg every 6-8 hours can reduce pain and inflammation, as recommended by 1. Some key points to consider when treating pharyngitis include:

• Using analgesics such as ibuprofen or paracetamol for symptom relief, as recommended by 1
• Considering antibiotics only in cases of confirmed streptococcal pharyngitis, as most cases are viral and will resolve on their own within 5-7 days, as stated by 1
• Using penicillin V, twice or three times daily for 10 days, as the first choice in patients with acute sore throat, as recommended by 1
• Avoiding the use of antibiotics in patients with less severe presentation of sore throat, e.g. 0–2 Centor criteria, to relieve symptoms, as stated by 1
• Considering the use of corticosteroids in conjunction with antibiotic therapy in adult patients with more severe presentations, e.g. 3–4 Centor criteria, as recommended by 1
• Staying hydrated with warm liquids like tea with honey to soothe irritation, as honey has natural antibacterial properties
• Resting and using a humidifier to speed recovery by keeping the throat moist and supporting the immune system. It's also important to note that most viral sore throats will resolve on their own within 5-7 days with supportive measures, and that antibiotics are usually not needed because they do little to alleviate symptoms and may have adverse effects, as stated by 1.

From the FDA Drug Label

When culture and susceptibility information are available, they should be considered in selecting or modifying antimicrobial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy The following Infections will usually respond to adequate dosage of Penicillin V: Streptococcal infections (without bacteremia): Mild to moderate infections of the upper respiratory tract, scarlet fever and mild erysipelas. Fusospirochetosis (Vincent's gingivitis and pharyngitis): Mild to moderately severe infections of the oropharynx usually respond to therapy with oral penicillin.

The best treatment for pharyngitis (sore throat) is penicillin V for mild to moderately severe infections caused by susceptible bacteria, such as streptococcal infections or fusospirochetosis. The choice of therapy should be guided by bacteriological studies and clinical response 2.

From the Research

Treatment Options for Pharyngitis

• The treatment of pharyngitis (sore throat) depends on the cause, with most cases being viral and not requiring antibiotics 3, 4, 5.
• For bacterial pharyngitis, antibiotics such as penicillin are recommended, but their use should be guided by clinical scores (Centor, McIsaac, FeverPAIN) to assess the risk of bacterial pharyngitis 3.
• Symptomatic treatment with ibuprofen and naproxen is recommended for patients with acute sore throat, regardless of the cause 3.
• Hexylresorcinol lozenges have been shown to have bactericidal activity against organisms associated with acute sore throat, and may be a useful adjunct to other treatments 6.

Antibiotic Use

• Antibiotics have been shown to reduce the duration of symptoms of sore throat, but the absolute benefits are modest 4, 5.
• The use of antibiotics should be balanced against the potential risks of antimicrobial resistance and other adverse effects 5.
• Penicillin is the first choice for antibiotic treatment, but other antibiotics such as cephalosporins may be effective alternatives, particularly in cases of penicillin failure 7.

Clinical Scores

• Clinical scores such as the Centor score can help guide the use of antibiotics in patients with sore throat, by assessing the risk of bacterial pharyngitis 3.
• The use of clinical scores can help reduce the overuse of antibiotics and minimize the risk of antimicrobial resistance 3, 5.

Symptomatic Relief

• Symptomatic relief is an important aspect of treating sore throat, and can be achieved with over-the-counter medications such as ibuprofen and naproxen 3.
• Hexylresorcinol lozenges may also provide symptomatic relief, in addition to their bactericidal activity 6.