What treatment is recommended for a sore throat?

Treatment for Sore Throat

For acute sore throat, start with ibuprofen as your first-line treatment, as it provides superior pain relief compared to paracetamol and has strong evidence supporting its safety and efficacy. 1

First-Line Analgesic Therapy

• Ibuprofen is the preferred systemic analgesic for acute pharyngitis, showing slightly better efficacy than paracetamol particularly within the first 2 hours of administration 1
• Paracetamol serves as an effective alternative when ibuprofen is contraindicated (such as in patients with renal impairment, peptic ulcer disease, or NSAID allergies) 2, 3
• Both medications are safe for short-term use when taken according to directions, with low risk of adverse effects 1

Important dosing consideration: Patients often use paracetamol ineffectively because they don't understand proper dosing schedules, leading to perceived treatment failure 4. Ensure patients understand to take these medications regularly (not just as needed) for optimal pain control.

Adjunctive Local Anesthetics

• Local anesthetics including lidocaine (8mg), benzocaine (8mg), and ambroxol (20mg) can be added as lozenges, throat sprays, or gargles for additional symptomatic relief 3, 5
• Among local anesthetics, ambroxol has the best documented benefit-risk profile 5

When to Consider Antibiotics

Use the Centor scoring system to guide antibiotic decisions 2:

• Centor 0-2 (mild presentation): Do NOT prescribe antibiotics - they provide no meaningful benefit and symptoms resolve with analgesics alone 1, 2
• Centor 3-4 (severe presentation): Consider antibiotics only after discussing modest benefits versus risks (side effects, antimicrobial resistance, costs) with the patient 1, 2

If antibiotics are indicated: Penicillin V given twice or three times daily for 10 days is the first-choice agent 2

What NOT to Use

• Avoid local antibiotics or antiseptics - they lack efficacy data and most sore throats are viral 1, 5
• Do not recommend zinc gluconate - conflicting efficacy results and increased adverse effects 1, 2
• Avoid herbal remedies or acupuncture - lack of reliable efficacy data 1, 2, 3
• Corticosteroids are not routinely recommended unless dealing with severe presentations (Centor 3-4) in conjunction with antibiotics 1, 2

Critical Clinical Pitfalls

• Many patients do not self-manage with analgesics before consulting, and physicians often wrongly assume they have already tried pain relief without actually exploring this 4
• Antibiotics do not prevent suppurative complications (quinsy, otitis media, sinusitis, mastoiditis) in most cases 2
• Antibiotics do not prevent rheumatic fever or glomerulonephritis in low-risk patients without prior rheumatic fever history 2
• Treatment should continue for at least 10 days for confirmed Streptococcus pyogenes infections to prevent acute rheumatic fever 6