Is rinsing with 2 spoons of salt in water an effective treatment for a sore throat?

Salt Water Gargling for Sore Throat

Salt water gargling can provide modest symptomatic relief for sore throat, but ibuprofen or paracetamol (acetaminophen) are the evidence-based first-line treatments you should recommend instead. 1

Evidence for Salt Water Gargling

The evidence base for salt water gargling is notably weak:

• The Infectious Diseases Society of America acknowledges that warm salt water rinses are "commonly used in clinical practice" but explicitly notes "this remedy has not been studied in detail" 2
• Guidelines consistently state there are "few data examining these approaches" for salt water and other topical mixtures 2
• Salt water falls into the category of topical agents that "may give temporary symptomatic relief" but lack robust clinical trial data 2

When gargling is used, the American Academy of Otolaryngology recommends three times per day (20 mL for 15 seconds, performed three times consecutively, at least three times daily), based on prevention studies showing 36% reduction in upper respiratory tract infections. 3 However, this evidence comes from prevention trials, not treatment studies.

Recommended First-Line Treatment

Either ibuprofen or paracetamol are the guideline-recommended treatments for acute sore throat symptom relief (Grade A-1 recommendation). 1

• Multiple randomized, double-blind, placebo-controlled studies support NSAIDs like ibuprofen for reducing fever and pain in pharyngitis 2
• Acetaminophen provides significant pain relief compared to placebo, though possibly less effective than ibuprofen 2

Important Clinical Considerations

When to Avoid Relying on Home Remedies Alone

• If sore throat persists beyond one week, or especially beyond two weeks, you must evaluate for serious complications, malignancy, or non-infectious causes like GERD 3, 4
• Most acute pharyngitis resolves within less than one week, with over 80% achieving complete resolution by 7 days 4
• Persistence beyond 2 weeks makes simple pharyngitis highly unlikely and mandates a different diagnostic approach 4

When Antibiotics Are Indicated

• Antibiotics should only be used for confirmed Group A Streptococcal pharyngitis (positive rapid antigen test or culture), not for symptomatic relief alone 2
• Testing should be considered in patients with 3-4 Centor criteria: fever, tonsillar exudates, tender anterior cervical adenopathy, absence of cough 2
• Antibiotics should not be used in patients with less severe presentation (0-2 Centor criteria) to relieve symptoms 1

Safety Considerations for Salt Water Gargling

• The primary limitation is whether the patient can safely gargle without choking or aspiration risk 2
• This is particularly relevant for young children, similar to how lozenges represent a choking hazard 2

Bottom Line

While salt water gargling is safe and may provide temporary relief through mechanical removal of inflammatory exudate and debris 3, the evidence-based approach is to use ibuprofen or paracetamol as first-line treatment 1, with salt water gargling as an optional adjunctive measure only. The amount of salt (2 spoons) mentioned in your question is not standardized in the literature, and no specific concentration has been validated for efficacy.