What is the best treatment for a sore throat in a 71-year-old patient with impaired renal function?

Treatment of Sore Throat in a 71-Year-Old with Impaired Renal Function

Start with ibuprofen or paracetamol (acetaminophen) for symptomatic relief, adjusting the dose appropriately for renal impairment, and reserve antibiotics only for severe presentations with 3-4 Centor criteria after careful risk-benefit assessment. 1

Initial Symptomatic Management

• Either ibuprofen or paracetamol are the recommended first-line treatments for acute sore throat symptoms in adults, with both showing equivalent efficacy and safety for short-term use 1, 2
• Ibuprofen may provide slightly superior pain relief compared to paracetamol, particularly after 2 hours of administration 3
• Critical caveat for renal impairment: NSAIDs like ibuprofen should be used with extreme caution or avoided in patients with significant renal dysfunction, making paracetamol the safer choice in this 71-year-old patient 1
• Paracetamol dosing does not require adjustment for mild-to-moderate renal impairment, though caution is warranted in severe cases 1

Assessment for Antibiotic Consideration

Use the Centor scoring system to guide antibiotic decision-making: 1, 4

• 0-2 Centor criteria: Do NOT use antibiotics - the presentation is too mild and antibiotics provide no meaningful benefit 1
• 3-4 Centor criteria: Consider antibiotics only after discussing modest benefits versus risks with the patient 1

The Centor criteria include: fever, tonsillar exudates, tender anterior cervical lymphadenopathy, and absence of cough 1

Antibiotic Therapy (If Indicated)

If antibiotics are warranted based on severe presentation (3-4 Centor criteria), penicillin V is the first-choice agent, given twice or three times daily for 10 days 1

Critical Renal Dosing Considerations:

• For patients with GFR 10-30 mL/min: Reduce penicillin dosing to 500 mg or 250 mg every 12 hours 5
• For patients with GFR <10 mL/min: Further reduce to 500 mg or 250 mg every 24 hours 5
• Patients should NOT receive 875 mg doses if GFR is less than 30 mL/min 5

What NOT to Use

• Zinc gluconate is not recommended for sore throat treatment 1, 2
• Herbal treatments and acupuncture have inconsistent evidence and should not be recommended 1, 2
• Local antibiotics or antiseptics lack efficiency data and should be avoided 6
• Corticosteroids are not routinely recommended, though they can be considered in severe presentations (3-4 Centor criteria) in conjunction with antibiotics 1

Key Clinical Pitfalls

Most sore throats are viral and self-limiting, resolving within 7 days without antibiotics 4, 7. The evidence shows that:

• Antibiotics do NOT prevent suppurative complications (quinsy, otitis media, sinusitis, mastoiditis) in most cases 1
• Antibiotics do NOT prevent rheumatic fever or glomerulonephritis in low-risk European patients without prior rheumatic fever history 1
• Even when indicated, antibiotics provide only modest symptom relief, which must be weighed against side effects, antimicrobial resistance, and costs 1

In this 71-year-old with renal impairment, the priority is paracetamol for symptom control, with extreme caution regarding both NSAIDs and any antibiotic dosing if bacterial infection is strongly suspected.