What is the appropriate use of Diflam (benzidamine) throat spray for children with sore throat symptoms?

Diflam (Benzydamine) Throat Spray for Children

Diflam (benzydamine hydrochloride) throat spray can be used in children for symptomatic relief of sore throat pain, but it is not a first-line treatment and should be reserved for cases where standard analgesics like ibuprofen or paracetamol are insufficient or contraindicated. 1

First-Line Treatment Approach

Before considering benzydamine spray, children with sore throat should receive:

• Ibuprofen or paracetamol as first-line analgesics for pain relief, as these are the most strongly recommended treatments with proven efficacy and safety in children 1
• A systematic review demonstrated no difference between ibuprofen and paracetamol in analgesic efficacy or safety for children with sore throat 1

When to Consider Benzydamine

Benzydamine may be appropriate when:

• Standard oral analgesics provide inadequate relief or cannot be used due to contraindications 2, 3
• Rapid onset of action is desired, as benzydamine provides pain relief starting at 2 minutes after administration with effects lasting up to 4 hours 4
• The child can cooperate with spray administration (typically age 6 years and older based on general spray formulation use) 5

Mechanism and Evidence

• Benzydamine is a locally-acting NSAID with combined local anesthetic, analgesic, and antiseptic properties that works directly at the site of inflammation 2, 3
• European consensus among healthcare professionals (>98% agreement) supports benzydamine's advantages over other topical treatments for sore throat 3
• However, benzydamine is not recommended by GPs and pharmacists as first-line treatment despite its efficacy, with only 40% of GPs prescribing it for pediatric patients 2

Important Caveats

• One pediatric study (ages 6-12 years) found benzydamine spray did NOT reduce postoperative sore throat when applied prophylactically to vocal cords and upper trachea, though this was in a post-intubation context rather than infectious pharyngitis 5
• The evidence base for benzydamine in children is limited compared to adults, with most high-quality studies focusing on adult populations 3, 4
• Antibiotics should only be used if group A streptococcal infection is confirmed by rapid antigen test or culture, not for symptomatic treatment 1, 6

Practical Algorithm

1. Start with oral ibuprofen or paracetamol 1
2. If inadequate relief after 1-2 hours, consider adding benzydamine spray 3, 4
3. If severe symptoms with difficulty swallowing, drooling, or neck swelling, urgently evaluate for peritonsillar abscess, retropharyngeal abscess, or epiglottitis 1, 7
4. Reserve antibiotics only for confirmed streptococcal pharyngitis 1, 6

The typical sore throat resolves in less than one week, and most cases are viral, requiring only symptomatic management 1, 6