Medications for Sore Throat
Either ibuprofen or paracetamol (acetaminophen) are the recommended first-line medications for relief of acute sore throat symptoms, with ibuprofen showing slightly better efficacy for pain relief. 1, 2, 3
Primary Treatment Options
Systemic Analgesics (First-Line)
Ibuprofen is the preferred first-line systemic analgesic for acute pharyngitis when no contraindications exist. 2, 3
- Ibuprofen demonstrates superior pain relief compared to paracetamol, particularly after 2 hours of administration. 2
- Clinical trials show ibuprofen is more effective than paracetamol on all rating scales at all time points after 2 hours. 4
- Both medications are safe when used according to directions for short-term treatment, with low risk of adverse effects. 2, 3
- The recommended starting dose of ibuprofen is 1.2g daily, which can be increased to 2.4g daily if needed. 5
Paracetamol (acetaminophen) serves as an effective alternative when ibuprofen is contraindicated or not tolerated. 1, 2, 3
- Both ibuprofen and paracetamol are equally effective and safe in children, with no significant difference in analgesic efficacy or safety between the two. 2, 3
Topical Anesthetics (Adjunctive)
Local anesthetic sprays or lozenges can be considered as adjunctive therapy for additional symptom relief. 3
- Topical agents containing lidocaine (8mg), benzocaine (8mg), or ambroxol (20mg) have confirmed efficiency in clinical trials. 6
- Phenol 1.4% oral anesthetic sprays are FDA-approved for sore throat relief in patients 2 years and older. 7
Medications NOT Recommended
Avoid These Treatments
Local antibiotics or antiseptics should NOT be used for sore throat treatment due to the mainly viral origin of sore throats and lack of efficacy data. 2, 3
Zinc gluconate is NOT recommended due to conflicting efficacy results and increased adverse effects in both trials that studied it. 1
Herbal treatments and acupuncture lack reliable efficacy data and should not be recommended, with all included studies showing high risk of bias or methodologically poor quality. 1, 2, 3
Corticosteroids (Limited Use Only)
Corticosteroids are NOT routinely recommended for sore throat treatment. 1, 3
- They can be considered in conjunction with antibiotic therapy ONLY in adult patients with severe presentations (3-4 Centor criteria). 1, 2
- No evidence of significant benefit was found in children. 1
- Studies were not sufficiently powered to detect adverse effects of short courses of oral corticosteroids. 1
Antibiotics (Selective Use)
Antibiotics are NOT indicated for symptom relief in patients with less severe presentations (0-2 Centor criteria). 2
- For patients with severe presentations (3-4 Centor criteria), the modest benefits of antibiotics must be weighed against side effects, impact on microbiota, antibiotic resistance, and costs. 2
- When antibiotics are indicated, penicillin V twice or three times daily for 10 days is the treatment option. 2
- Amoxicillin is an alternative antibacterial option, though it is primarily indicated for bacterial infections rather than symptomatic relief. 8
Common Pitfalls to Avoid
Many patients do not self-manage their sore throat with paracetamol before consulting, and physicians often wrongly assume patients have already tried pain relief without actually exploring this. 9
Patients who do use paracetamol often do not know how to use it effectively (adequate dosing, regular intervals), leading to the false perception that it is insufficient for treating acute sore throat. 9
Antibiotics are still frequently prescribed as first-line management despite guidelines recommending analgesics first, contributing to unnecessary antibiotic resistance. 10, 9