What can pregnant patients take to treat a sore throat?

Treatment of Sore Throat in Pregnancy

Pregnant patients with sore throat should use acetaminophen (paracetamol) for symptomatic pain relief and saline gargles, with penicillin or ampicillin as first-line antibiotics if bacterial tonsillitis is confirmed, while strictly avoiding NSAIDs (especially ibuprofen) and oral decongestants. 1

Symptomatic Relief Options

Safe First-Line Treatments

• Acetaminophen (paracetamol) is the recommended analgesic for pain and fever control during pregnancy 1
• Use at the lowest effective dose for the shortest duration necessary, as emerging evidence suggests potential neurodevelopmental concerns with prolonged exposure 2, 3
• Saline gargles are completely safe and provide symptomatic relief without any fetal risk 1

Medications to Strictly Avoid

• NSAIDs (including ibuprofen) must be avoided, particularly after 20 weeks gestation, due to risks of premature ductus arteriosus closure, oligohydramnios, intrauterine growth restriction, and perinatal mortality 4, 5, 6
• Oral decongestants should not be used, especially during the first trimester, as they are associated with fetal gastroschisis, small intestinal atresia, and maternal hypertension 7, 1, 8
• Aspirin is Category D and poses unacceptable fetal risks including premature ductus arteriosus closure 7, 9

Antibiotic Treatment for Bacterial Tonsillitis

When Bacterial Infection is Confirmed

• Penicillin G or ampicillin are the preferred first-line antibiotics due to their narrow spectrum and established safety profile 1
• For non-anaphylactic penicillin allergy, first-generation cephalosporins (e.g., cefazolin) are recommended 1

Alternative Antibiotics

• Clindamycin can be used if the bacterial isolate is susceptible 1
• Erythromycin is an alternative for susceptible isolates 1
• Vancomycin may be used when susceptibility testing is unavailable or isolates are resistant to clindamycin and erythromycin 1

Adjunctive Therapies for Associated Symptoms

For Nasal Congestion or Rhinitis Symptoms

• Intranasal corticosteroids (budesonide, fluticasone, mometasone) are safe during pregnancy and can be used for associated nasal symptoms 1, 9, 8
• Saline nasal rinses are completely safe and effective for symptom relief 9, 8

Critical Timing Considerations

First Trimester (Weeks 1-12)

• The first trimester carries the highest risk for medication-induced teratogenicity, so exercise particular caution during this period 1, 8
• Avoid all oral decongestants during this window due to congenital malformation risks 1, 9

After 20-30 Weeks Gestation

• Avoid all NSAIDs starting at 20 weeks due to risk of oligohydramnios and premature ductus arteriosus closure 4, 5, 6
• If acetaminophen is needed between 20-30 weeks for more than 48 hours, monitor for oligohydramnios 4

Clinical Pitfalls to Avoid

• Do not assume all over-the-counter pain relievers are safe—many contain NSAIDs or decongestants that are contraindicated 4, 5
• Avoid tetracyclines, aminoglycosides, trimethoprim-sulfamethoxazole, and fluoroquinolones during pregnancy 1
• Do not withhold acetaminophen when medically indicated for fever or severe pain, as untreated high fever poses greater maternal-fetal risks than appropriate acetaminophen use 2, 3
• Consider consultation with obstetrics for severe infections or complications 1