What are the recommended medications for treating a sore throat?

Recommended Medications for Sore Throat

Either ibuprofen or paracetamol (acetaminophen) are the recommended first-line medications for acute sore throat, with ibuprofen showing slightly superior efficacy for pain relief. 1, 2, 3

Primary Analgesic Treatment

Ibuprofen is the preferred first-line systemic analgesic for acute sore throat when no contraindications exist, providing effective pain relief with a low risk of adverse effects. 2, 3, 4 The evidence demonstrates that ibuprofen reduces throat soreness and fever by approximately half, with the greatest benefit seen at day three. 5

• Ibuprofen shows superior efficacy compared to paracetamol, particularly after 2 hours of administration and for overall pain relief. 4, 6
• Clinical trials demonstrate ibuprofen has the best benefit-risk profile among systemic analgesics for sore throat. 7
• Both medications are safe when used according to directions for short-term treatment. 2, 3

Paracetamol (acetaminophen) serves as an effective alternative when ibuprofen is contraindicated or not tolerated, with strong evidence supporting its use for sore throat pain. 2, 3

Adjunctive Local Anesthetics

Local anesthetics can be added for additional symptomatic relief when systemic analgesics alone are insufficient. 2, 3

• Lidocaine (8 mg), benzocaine (8 mg), and ambroxol (20 mg) are available as lozenges, throat sprays, or gargles with confirmed efficacy in clinical trials. 2, 7
• Among local anesthetics, ambroxol has the best documented benefit-risk profile. 7
• Flurbiprofen 8.75 mg lozenge provides effective relief of sore throat, difficulty swallowing, and swollen throat, particularly in patients with relatively severe symptoms. 8

What NOT to Use

Avoid these treatments due to lack of efficacy or safety concerns:

• Local antibiotics or antiseptics should NOT be used due to lack of efficacy data and the predominantly viral origin of most sore throats. 2, 3, 7
• Zinc gluconate is not recommended due to conflicting efficacy results and increased adverse effects. 1, 3, 4
• Herbal treatments and acupuncture should not be used due to inconsistent evidence and lack of reliable data supporting their efficacy. 1, 2, 3

Corticosteroids: Limited Role

Corticosteroids are NOT routinely recommended for sore throat treatment. 1, 3, 4

• They can be considered only in adult patients with severe presentations (3-4 Centor criteria) when used in conjunction with antibiotic therapy. 1, 4
• No evidence of significant benefit exists in children. 1
• The effect is considerably smaller in typical primary-care populations where most patients do not have severe presentations. 1

Clinical Algorithm

1. Rule out red flags requiring urgent evaluation (severe refractory symptoms, immunosuppression, signs of abscess, epiglottitis, or Lemierre syndrome). 2
2. Start ibuprofen as first-line therapy for pain control, unless contraindicated. 2, 3, 4
3. Use paracetamol as alternative if ibuprofen is contraindicated or not tolerated. 2, 3
4. Consider adding local anesthetics (lidocaine, benzocaine, or ambroxol) for additional symptom relief if needed. 2, 3, 7
5. Avoid antibiotics, antiseptics, and alternative therapies in the absence of confirmed bacterial infection. 2, 3

Important Pitfalls

• Antibiotics shorten symptom duration by only about 16 hours overall and require treating many patients for one to benefit from preventing complications. 5
• The number needed to treat to prevent one sore throat at day three is less than six, but increases to 21 at week one. 5
• Even when clinical scores suggest bacterial cause, antibiotic treatment only modestly shortens symptom duration. 9