What is the first-line treatment for cough and sore throat?

First-Line Treatment for Cough and Sore Throat

Either ibuprofen or paracetamol (acetaminophen) are recommended as first-line treatments for relief of acute sore throat symptoms and cough. 1, 2

Analgesic Options

• Ibuprofen appears to have slightly better efficacy than paracetamol for pain relief in sore throat, particularly after 2 hours of administration 2, 3, 4
• Both medications are considered safe when used according to directions for short-term treatment of sore throat pain, with a low risk of adverse effects 2, 5
• In a direct comparison study, ibuprofen 400 mg was more effective than paracetamol 1000 mg for sore throat pain relief at all time points after 2 hours 4
• Ibuprofen has been shown to be as well tolerated as paracetamol and better tolerated than aspirin for treatment of cold/flu symptoms and sore throat pain 5

Treatment Algorithm

For Sore Throat:

1. First-line treatment: Oral analgesics - ibuprofen or paracetamol 1, 2

   • Ibuprofen: Preferred for better pain relief 3, 4
   • Paracetamol: Alternative if ibuprofen is contraindicated 2, 3

2. Local treatments (can be used alongside oral analgesics):

   • Local anesthetics with confirmed efficacy: lidocaine (8mg), benzocaine (8 mg), or ambroxol (20 mg) 6
   • Among these, ambroxol has the best documented benefit-risk profile 6

For Cough:

1. First-line treatment: For cough due to throat irritation, dextromethorphan can be used to temporarily relieve cough 7
2. For chronic bronchitis: Central cough suppressants such as codeine and dextromethorphan are recommended for short-term symptomatic relief 1

Important Considerations

• Antibiotics should not be used in patients with less severe presentation of sore throat (0-2 Centor criteria) to relieve symptoms 1, 8
• Local antibiotics or antiseptics should not be recommended due to the mainly viral origin of sore throats and lack of efficacy data 3, 6
• Zinc gluconate is not recommended for use in sore throat treatment 1, 3
• Complementary treatments such as herbal remedies and acupuncture have inconsistent evidence and are not recommended as primary treatment 1, 3

Special Situations

• For more severe presentations of sore throat (3-4 Centor criteria), corticosteroids may be considered in conjunction with antibiotic therapy in adult patients 1, 3
• If antibiotics are indicated (based on clinical scoring systems like Centor, McIsaac, or FeverPAIN), penicillin V twice or three times daily for 10 days is recommended 1, 8, 9
• For patients allergic to penicillin, alternatives include first-generation cephalosporins, clindamycin, or macrolide antibiotics 9

Pitfalls to Avoid

• Overprescribing antibiotics: Less than 35% of sore throat cases are caused by bacterial infections, yet antibiotics are prescribed far more often 8
• Using zinc gluconate: Despite some use in common cold symptoms, it is not recommended for sore throat 1, 3
• Relying on herbal treatments: These have inconsistent evidence and should not replace proven analgesics 1