Treatment of Sore Throat in Children Under 12
For children under 12 with sore throat, use ibuprofen or paracetamol (acetaminophen) for symptom relief; there is no guideline recommendation for thymol gargle or saltwater rinse as these lack sufficient evidence for efficacy. 1
Recommended Symptomatic Treatment
Either ibuprofen or paracetamol are the recommended first-line agents for relief of acute sore throat symptoms in children. 1 These medications provide effective pain relief and fever reduction with well-established safety profiles in pediatric populations. 2
- The evidence supporting these analgesics is strong (Level 1A+ evidence from meta-analyses). 1
- Both medications have comparable efficacy for sore throat pain relief. 1
Why Not Thymol Gargle or Saltwater Rinse?
The 2012 European guideline on acute sore throat management specifically searched for evidence on "mouthwashes, throat spray, lozenges, and gargles" but found insufficient evidence to recommend these interventions. 1
- Only 86 studies were identified in their comprehensive search on gargles and mouth rinses, and none provided sufficient evidence to warrant a guideline recommendation. 1
- There is inconsistent evidence supporting complementary therapies including gargles for sore throat. 2
- The guideline authors concluded that herbal treatments and other complementary approaches lack robust supporting data. 2
When to Consider Antibiotics
Most sore throats in children are viral and self-limiting. 2, 3
Antibiotics should NOT be used in children with mild presentations (0-2 Centor criteria). 2
If antibiotics are indicated based on clinical severity (3-4 Centor criteria) or positive streptococcal testing, penicillin V twice or three times daily for 10 days is the first-line treatment. 1, 2
- Amoxicillin is an acceptable alternative in younger children due to better taste and availability as syrup. 2, 3
- The modest benefits of antibiotics (1-2 days symptom reduction) must be weighed against side effects, impact on microbiota, and increased resistance. 2
Common Pitfalls to Avoid
- Do not prescribe antibiotics for viral sore throats (most cases with 0-2 Centor criteria), as this increases resistance without clinical benefit. 2
- Do not rely on unproven remedies like gargles when evidence-based analgesics (ibuprofen/paracetamol) are available and effective. 1
- Do not use zinc gluconate for sore throat in children, as it is not recommended. 2