Can lignocaine (lidocaine) spray be used for severe sore throat?

Use of Lignocaine Spray for Severe Sore Throat

Lignocaine spray is not recommended for routine use in severe sore throat as it is not FDA-approved for this indication and guidelines recommend other first-line treatments. 1, 2

First-Line Treatment Recommendations

• Ibuprofen or paracetamol (acetaminophen) are the recommended first-line treatments for relief of acute sore throat symptoms, including severe cases 2, 3
• These analgesics have been proven more effective than placebo for reducing acute sore throat symptoms in both adults and children 2
• Ibuprofen and diclofenac are slightly more effective than paracetamol for pain relief, though paracetamol and ibuprofen have better safety profiles 2

Evidence Regarding Lignocaine (Lidocaine) for Sore Throat

• The FDA-approved indications for lidocaine (lignocaine) topical preparations do not include treatment of sore throat; they are approved for urethral procedures and endotracheal intubation 1
• Research on lidocaine lozenges (8 mg) has shown some efficacy for acute pharyngitis pain relief compared to placebo, but this formulation is not widely available and not mentioned in current guidelines 4
• A study comparing 8 mg lidocaine + 2 mg CPC lozenges with 1 mg lidocaine + 2 mg CPC lozenges found no significant advantage of the higher lidocaine dose for sore throat pain relief 5
• Some evidence suggests lignocaine spray may actually increase post-operative sore throat when used during intubation 6

Treatment Algorithm for Severe Sore Throat

1. First step: Use recommended analgesics

   • Start with ibuprofen or paracetamol for pain relief 2, 3
   • These can be used at regular intervals as needed for symptom control 2

2. For severe cases (3-4 Centor criteria):

   • Consider corticosteroids in conjunction with antibiotic therapy in adult patients 2
   • Corticosteroids should not be used routinely but may benefit adults with severe presentations 2

3. If bacterial infection is suspected:

   • Use clinical scoring systems (Centor criteria) to assess likelihood of streptococcal infection 3, 7
   • Consider rapid antigen testing in patients with 3-4 Centor criteria 3
   • If antibiotics are indicated, penicillin V for 10 days is the recommended first choice 2, 3, 7

Important Considerations and Cautions

• Most sore throats (>65%) are viral in origin and resolve within one week without specific treatment 3
• Antibiotics should not be used in patients with less severe presentations (0-2 Centor criteria) 2, 3
• Zinc gluconate is not recommended for use in sore throat due to inconsistent evidence and potential side effects 2, 3
• Herbal treatments and acupuncture have inconsistent evidence supporting their use for sore throat 2, 3

Pitfalls to Avoid

• Using non-approved medications like lignocaine spray when evidence-based alternatives exist 1, 2
• Initiating antibiotic therapy without confirming bacterial infection 3, 7
• Using broad-spectrum antibiotics when narrow-spectrum penicillins are effective for confirmed streptococcal infections 7
• Neglecting to provide adequate analgesic therapy, which is the cornerstone of symptomatic relief 2