Treatment for Sore Throat Pain
For acute sore throat pain, use ibuprofen or paracetamol (acetaminophen) as first-line treatment, with ibuprofen showing slightly better efficacy for pain relief. 1
Primary Analgesic Therapy
Ibuprofen and paracetamol are the recommended first-line treatments for all patients with acute sore throat pain, regardless of bacterial or viral etiology. 1
- Ibuprofen demonstrates superior efficacy compared to paracetamol, particularly after 2 hours of administration and for overall pain relief 2, 3
- Both medications are safe when used according to directions for short-term treatment, with low risk of adverse effects 2, 4
- Systemic analgesics like ibuprofen provide better evidence-based relief than local treatments 5
Treatment Algorithm
Step 1: Rule Out Red Flags
- Exclude severe systemic infection, immunosuppression, signs of abscess, epiglottitis, or Lemierre syndrome before initiating symptomatic treatment 4, 6
Step 2: Initiate Analgesic Therapy
- Start with ibuprofen as the preferred first-line agent for optimal pain control 2, 4, 3
- Use paracetamol as an alternative if ibuprofen is contraindicated or not tolerated 2, 4
- Ensure patients understand proper dosing—many patients use inadequate doses, leading to perceived treatment failure 7
Step 3: Consider Adjunctive Local Anesthetics
- Local anesthetics (lidocaine 8mg, benzocaine 8mg, or ambroxol 20mg lozenges) can be added for additional symptomatic relief 4, 5
- Ambroxol has the best documented benefit-risk profile among local anesthetics 5
Step 4: Assess Need for Antibiotics (Only if Considering)
- Do NOT prescribe antibiotics for patients with 0-2 Centor criteria 1
- For patients with 3-4 Centor criteria, discuss the modest benefits versus risks (side effects, antibiotic resistance, microbiota disruption) 1, 2
- If antibiotics are indicated, use penicillin V twice or three times daily for 10 days 1
What NOT to Use
Avoid these treatments due to lack of efficacy or potential harm:
- Local antibiotics or antiseptics—no efficacy data and most sore throats are viral 4, 5
- Zinc gluconate—not recommended due to conflicting efficacy and increased adverse effects 1, 2
- Herbal treatments and acupuncture—inconsistent evidence, not reliable 1, 2, 8
Special Considerations for Severe Presentations
- Corticosteroids can be considered in adult patients with severe presentations (3-4 Centor criteria) when used in conjunction with antibiotic therapy 1, 2
- Corticosteroids are NOT routinely recommended and should NOT be used in patients with mild presentations (0-2 Centor criteria) 2
- No evidence supports corticosteroid use in children 8
Common Pitfalls to Avoid
Many patients do not use paracetamol before consulting a physician, and physicians often wrongly assume they have already tried it. 7
- Actively explore what the patient has already tried—don't assume they've used analgesics appropriately 7
- Educate patients on proper dosing—inadequate dosing leads to perceived treatment failure and unnecessary antibiotic requests 7
- Provide thorough explanations—patients generally accept recommended treatment when given clear rationale, as they trust physician expertise 7
- Avoid routine antibiotic prescribing—antibiotics provide only modest symptom reduction (shortening duration by approximately 1 day) and should not be used to prevent complications in low-risk patients 1, 6