What is the treatment approach for a sore throat?

Treatment Approach for Sore Throat

For acute sore throat, either ibuprofen or paracetamol (acetaminophen) is recommended as first-line treatment for symptom relief, with antibiotics reserved only for cases with high likelihood of streptococcal infection. 1, 2

Diagnostic Approach

• Most sore throats are of viral origin, occurring as part of the common cold, with bacterial pathogens (primarily Streptococcus pyogenes) causing only a minority of cases 1
• The Centor clinical scoring system helps identify patients with higher likelihood of streptococcal infections based on clinical features 1:
  • Fever >38.5°C
  • Absence of cough
  • Tender anterior cervical adenopathy
  • Tonsillar exudate
• In patients with high likelihood of streptococcal infections (3-4 Centor criteria), rapid antigen testing (RAT) can be considered 1
• If RAT is performed and negative, throat culture is not necessary for diagnosis of group A streptococci 1
• Routine use of biomarkers (e.g., C-reactive protein, procalcitonin) is not necessary in the assessment of acute sore throat 1

Treatment Algorithm

Symptomatic Treatment (First Line)

• Either ibuprofen or paracetamol is recommended for relief of acute sore throat symptoms, with ibuprofen showing slightly better efficacy for pain relief 1, 2, 3
• Topical treatments such as lozenges, sprays, or gargles may provide additional symptomatic relief 2
• Ensure adequate hydration and rest during recovery 4

Antibiotic Treatment (When Indicated)

• Antibiotics should NOT be used in patients with less severe presentation (0-2 Centor criteria) 1
• For patients with more severe presentations (3-4 Centor criteria), modest benefits of antibiotics must be weighed against side effects, impact on microbiota, increased resistance, and costs 1
• If antibiotics are indicated (based on clinical criteria or positive testing):
  • Penicillin V, twice or three times daily for 10 days, is the recommended first-line treatment 1, 5
  • For patients allergic to penicillin, macrolides (e.g., clarithromycin) or clindamycin are alternatives 6

Special Considerations

• Corticosteroids are not routinely recommended but can be considered in adult patients with severe presentations (3-4 Centor criteria) in conjunction with antibiotic therapy 1, 3
• Zinc gluconate is not recommended for use in sore throat due to conflicting efficacy results 1, 2
• There is inconsistent evidence supporting herbal treatments or acupuncture for sore throat 1, 7

Common Pitfalls to Avoid

• Overuse of antibiotics for viral sore throats - most cases are viral and self-limiting, resolving within 7 days 5, 4
• Treating with antibiotics to prevent rheumatic fever in low-risk patients (those with no previous history of rheumatic fever) is not indicated 1
• Failure to use clinical scoring systems (Centor criteria) to guide antibiotic use decisions 1, 5
• Not providing adequate patient education about the self-limiting nature of most sore throats and effective self-management strategies 4

Patient Education Points

• Most sore throats are viral and self-limiting, typically resolving within 7 days 5, 4
• Analgesics like ibuprofen or paracetamol are effective for symptom relief 1, 2
• Antibiotics provide minimal benefit for most sore throats and come with potential side effects 1, 4
• Red flag symptoms requiring immediate medical attention include difficulty breathing, inability to swallow fluids, or severe pain unresponsive to analgesics 8