What is a recommended spray for a sore throat?

Recommended Sore Throat Sprays

For symptomatic relief of sore throat, flurbiprofen 8.75 mg spray is the most evidence-based topical spray option, providing rapid pain relief within 5 minutes and sustained relief for up to 6 hours. 1

First-Line Spray Options

Flurbiprofen 8.75 mg Spray (Preferred)

• Flurbiprofen spray demonstrates superior efficacy compared to placebo, with significantly greater reduction in throat soreness starting at 5 minutes post-application and lasting up to 6 hours. 1
• This NSAID spray targets both pain and inflammation directly at the site of infection, making it particularly effective for upper respiratory tract infections. 1
• The spray is well-tolerated with no significant difference in adverse events compared to placebo over 3 days of use. 1
• Can be re-dosed every 3-6 hours as needed (maximum 5 doses per day). 1

Phenol 1.4% Spray (Alternative)

• Phenol-based sprays (such as Chloraseptic® or generic equivalents) are available as oral anesthetic/analgesic sprays for sore throat relief. 2
• These work as local anesthetics but lack the anti-inflammatory properties of flurbiprofen. 2
• Important safety warning: Do not use for more than 2 days; if sore throat is severe or persists beyond 2 days, consult a doctor. 2
• Not recommended for children under 2 years of age. 2

What NOT to Use

Antiseptic Sprays

• Local antibiotics or antiseptics should NOT be recommended for sore throat treatment due to the mainly viral origin of sore throats and lack of efficacy data. 3
• The CDC recommends against these products specifically. 4

Herbal or Alternative Sprays

• There is inconsistent evidence for herbal treatments, and they should not be recommended for sore throat management. 5
• Studies on herbal preparations were of poor methodological quality with high risk of bias. 5

Clinical Algorithm for Spray Selection

Step 1: Assess severity and duration

• If sore throat has been present for >2 days or is severe with high fever, headache, nausea, or vomiting, do not rely on spray alone—evaluate for bacterial infection. 2

Step 2: Choose appropriate spray

• First choice: Flurbiprofen 8.75 mg spray for patients without contraindications to NSAIDs (no renal impairment, no history of GI bleeding, not pregnant). 1
• Alternative: Phenol 1.4% spray for patients who cannot use NSAIDs or prefer a local anesthetic approach. 2

Step 3: Combine with systemic therapy

• Always recommend systemic analgesics (ibuprofen or paracetamol) as the primary treatment, with sprays as adjunctive therapy. 4
• Ibuprofen shows slightly better efficacy than paracetamol for pain relief. 5, 4

Important Caveats

Renal Impairment Considerations

• For patients with renal impairment, avoid flurbiprofen spray and use phenol spray instead, combined with systemic paracetamol rather than ibuprofen. 6

Duration Limitations

• Phenol sprays should not be used for more than 2 days without medical consultation. 2
• If symptoms persist beyond 2 days or worsen, re-evaluate for bacterial infection using Centor criteria. 4, 6

Pregnancy and Breastfeeding

• Consult a healthcare professional before using phenol sprays during pregnancy or breastfeeding. 2
• Systemic paracetamol is safer than NSAIDs in pregnancy. 6

Common Pitfall

• Do not prescribe antibiotics for patients with 0-2 Centor criteria, as antibiotics provide no meaningful benefit and contribute to resistance. 4, 6
• Even with 3-4 Centor criteria, antibiotics provide only modest symptom relief (approximately 16 hours overall reduction) and must be weighed against side effects and resistance concerns. 7