What is the best treatment for a scratchy red throat?

Treatment of Scratchy Red Throat

For a scratchy red throat, start with ibuprofen as your first-line treatment, as it provides superior pain relief compared to other over-the-counter options and has an excellent safety profile for short-term use. 1

First-Line Symptomatic Treatment

Ibuprofen is the preferred analgesic for acute sore throat based on the strongest evidence:

• Ibuprofen demonstrates better efficacy than paracetamol (acetaminophen) for throat pain relief, particularly after 2 hours of administration 2
• The recommended dose is up to 1200 mg daily (typically 400 mg every 6-8 hours) for adults 3
• Ibuprofen is as well-tolerated as paracetamol when used short-term for sore throat, with comparable rates of adverse events (12.0% vs 12.3%) 3
• Both the American College of Physicians and European Society of Clinical Microbiology recommend ibuprofen as first-line therapy if no contraindications exist 1, 4

Paracetamol (acetaminophen) serves as an effective alternative when ibuprofen is contraindicated:

• Use up to 3000 mg daily in divided doses for adults 3
• Particularly appropriate for patients with gastrointestinal concerns, bleeding disorders, or during breastfeeding 5
• Provides effective pain relief though slightly less potent than ibuprofen 2

Adjunctive Topical Treatments

Local anesthetic agents can provide additional symptomatic relief when systemic analgesics alone are insufficient:

• Phenol spray (1.4%): Apply one spray to affected area, allow to remain for at least 15 seconds, then spit out; use every 2 hours as needed 6
• Other effective local anesthetics include lidocaine (8 mg), benzocaine (8 mg), and ambroxol (20 mg) in lozenge or spray form 7
• These agents provide temporary relief and can be used alongside systemic analgesics 1, 4

Treatment Algorithm

1. Rule out red flags first requiring urgent evaluation: severe refractory symptoms, immunosuppression, signs of abscess, epiglottitis, or severe systemic infection 4

2. Start ibuprofen 400 mg every 6-8 hours (maximum 1200 mg/day) as first-line therapy 1

3. Add topical anesthetic spray or lozenges if pain control is inadequate with ibuprofen alone 1, 7

4. Switch to paracetamol if ibuprofen is contraindicated or not tolerated 1, 4

5. Reassess if symptoms persist beyond 7 days or worsen, as most viral sore throats are self-limiting within this timeframe 8

Critical Pitfalls to Avoid

Do NOT use the following treatments as they lack efficacy or carry unnecessary risks:

• Local antibiotics or antiseptics: No efficacy data supports their use, and most sore throats are viral in origin 1, 7
• Zinc gluconate: Conflicting efficacy results with increased adverse effects 1
• Herbal remedies or alternative treatments: No reliable data supporting efficacy 1, 4
• Routine corticosteroids: Not recommended for self-care settings; only consider under medical supervision for severe presentations with confirmed bacterial infection 1, 5

When to Consider Antibiotics

Antibiotics are NOT indicated for most scratchy red throats, as over 65% are viral in origin 8:

• Only consider antibiotics if clinical scoring suggests high probability of Group A Streptococcal infection (Centor score ≥3 or FeverPAIN score >3) 8
• Even with bacterial pharyngitis, antibiotics only modestly shorten symptom duration 8
• Most sore throats resolve within 7 days without antibiotics 8

Duration and Follow-Up

• Symptomatic treatment can be continued for up to 7 days as needed 3
• Most acute sore throats are self-limiting and resolve within 7 days without specific treatment 8
• Seek medical evaluation if symptoms worsen or fail to improve within 48-72 hours, or if red flag symptoms develop 5, 4