What is the best medication for inpatient management of acute pharyngitis (sore throat)?

Best Medication for Inpatient Management of Acute Pharyngitis

Ibuprofen or paracetamol (acetaminophen) are the recommended first-line medications for inpatient management of acute pharyngitis, with ibuprofen showing slightly better efficacy for pain relief. 1, 2

First-Line Analgesic Options

• Ibuprofen and paracetamol are both effective for reducing acute sore throat symptoms, with strong evidence supporting their use as first-line treatments 1
• Ibuprofen appears to have slightly better efficacy than paracetamol for pain relief, particularly after 2 hours of administration 2, 3
• Both medications are considered safe when used according to directions for short-term treatment of sore throat pain 2
• For patients with moderate-to-severe sore throat with evidence of tonsillo-pharyngitis, flurbiprofen 8.75 mg lozenges can provide effective relief of sore throat pain, difficulty swallowing, and sensation of a swollen throat 4

Treatment Algorithm for Inpatient Management

1. First-line systemic analgesics:

   • Ibuprofen (preferred if no contraindications) 1, 2
   • Paracetamol (acetaminophen) as an alternative 1, 2

2. Adjunctive therapy options:

   • Local anesthetic lozenges or sprays containing lidocaine, benzocaine, or ambroxol for additional symptom relief 5
   • Flurbiprofen lozenges (8.75 mg) for patients with significant pharyngeal inflammation 4

3. For severe presentations in adults (3-4 Centor criteria):

   • Consider corticosteroids in conjunction with antibiotic therapy 1
   • Single-dose corticosteroids can increase the likelihood of pain resolution at 24 hours by more than three times 6

Important Considerations and Pitfalls

• Local antibiotics or antiseptics should not be used for sore throat treatment due to the mainly viral origin of sore throats and lack of efficacy data 2, 5
• Many patients do not self-manage their acute sore throat with appropriate doses of analgesics before seeking medical care, leading to the perception that these medications are ineffective 7
• Proper patient education about effective analgesic use is crucial - patients should be instructed to take regular doses rather than as-needed 7
• Zinc gluconate is not recommended for sore throat treatment due to conflicting efficacy results and increased adverse effects 1
• There are no reliable data supporting the efficacy of alternative treatments such as herbal remedies or acupuncture for sore throat 1, 2

Antibiotic Considerations

• Antibiotics should not be used in patients with less severe presentation of sore throat (0-2 Centor criteria) to relieve symptoms 1
• For patients with more severe presentations (3-4 Centor criteria), modest benefits of antibiotics must be weighed against side effects, impact on microbiota, antibiotic resistance, and costs 1
• If antibiotics are indicated, penicillin V twice or three times daily for 10 days is recommended 1

Special Populations

• Both ibuprofen and paracetamol are effective for sore throat symptoms in children, with no significant difference in analgesic efficacy or safety between the two 2
• For pediatric patients with pharyngitis/tonsillitis requiring antibiotics, azithromycin can be considered at 12 mg/kg once daily for 5 days 8