What is the treatment for an inflamed throat?

Treatment of Inflamed Throat

The first-line treatment for an inflamed throat (acute pharyngitis) is either ibuprofen or paracetamol (acetaminophen) for symptom relief. 1, 2

First-Line Analgesic Options

• 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, with a low risk of adverse effects 2, 4
• Non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol are more effective than placebo for reducing acute sore throat symptoms in both adults and children 1

Antibiotic Considerations

• Antibiotics should not be used in patients with less severe presentation of sore throat (0-2 Centor criteria) to relieve symptoms 1, 2
• For patients with more severe presentations (3-4 Centor criteria), modest benefits of antibiotics must be weighed against side effects, impact on microbiota, increased antibiotic resistance, and costs 1, 5
• If antibiotics are indicated (based on positive streptococcal test or severe presentation), penicillin V twice or three times daily for 10 days is recommended 1
• Sore throat is mainly viral in origin (>65% of cases), making antibiotics unnecessary in most cases 3, 4
• Clinical scoring systems (Centor, McIsaac, FeverPAIN) should be used to assess the risk of bacterial pharyngitis before considering antibiotics 4, 6

Adjunctive Treatments

• Corticosteroids in conjunction with antibiotic therapy are not routinely recommended but can be considered in adult patients with severe presentations (3-4 Centor criteria) 1, 2
• Zinc gluconate is not recommended for sore throat treatment due to conflicting efficacy results and increased adverse effects 1, 2
• Local antibiotics or antiseptics are not recommended due to the mainly viral origin of sore throats and lack of efficacy data 2, 3
• There is inconsistent evidence supporting herbal treatments and acupuncture for sore throat, and they are not recommended as primary treatment 1

Treatment Algorithm

1. Assess severity using clinical scoring systems (Centor criteria) 1, 6
2. For symptomatic relief, prescribe ibuprofen or paracetamol as first-line treatment 1, 2
3. Consider throat lozenges, salt water gargles, or local anesthetics (lidocaine, benzocaine, ambroxol) for additional symptomatic relief 3
4. For severe presentations (3-4 Centor criteria), consider testing for Group A Streptococcus 1
5. If bacterial infection is confirmed or strongly suspected in severe cases, prescribe penicillin V for 10 days 1
6. In adults with severe symptoms, consider adding a single dose of corticosteroids 1, 2

Common Pitfalls and Caveats

• Overuse of antibiotics for sore throat is common despite evidence that most cases are viral 4, 6
• Even in bacterial cases, antibiotics only modestly reduce symptom duration (by 1-2 days) 1, 5
• Patients should be informed that the typical course of a sore throat is less than one week, and most will resolve without antibiotics 1, 4
• When using clinical scoring systems, remember that they help target antibiotic use but are not perfect predictors of bacterial infection 1, 6