What is the treatment for a sudden sore throat?

Treatment of Sudden Sore Throat

Start with ibuprofen or paracetamol for symptom relief, and avoid antibiotics unless the patient has 3-4 Centor criteria indicating high likelihood of streptococcal infection. 1, 2

Initial Symptomatic Management

First-line analgesics are the cornerstone of treatment for acute sore throat:

• Ibuprofen is preferred over paracetamol as it demonstrates slightly better efficacy for pain relief, particularly within 2 hours of administration 2
• Paracetamol remains an acceptable alternative if ibuprofen is contraindicated 1, 2
• Both medications are safe for short-term use with low risk of adverse effects 2
• Administer at the start of meals to minimize gastrointestinal intolerance 3

Clinical Assessment Algorithm

Use the Centor criteria to stratify patients and guide antibiotic decisions:

For patients with 0-2 Centor criteria (low severity):

• Do NOT prescribe antibiotics - these cases are predominantly viral and self-limiting 1, 2
• Continue symptomatic treatment with analgesics only 1, 2
• No need for rapid antigen testing (RAT) or throat culture 1

For patients with 3-4 Centor criteria (high severity):

• Consider RAT to confirm streptococcal infection 1
• If RAT is negative, throat culture is NOT necessary 1
• Discuss antibiotic benefits versus risks with the patient, emphasizing that benefits are modest (symptom reduction by 1-2 days) 1, 4
• Weigh against side effects, microbiota disruption, antibiotic resistance, and costs 1

Antibiotic Therapy (When Indicated)

If antibiotics are warranted after shared decision-making:

• Penicillin V is the first-line choice: 500 mg twice or three times daily for 10 days 1, 4, 5
• Amoxicillin is an acceptable alternative, particularly in children due to better palatability 4, 3
• Complete the full 10-day course to prevent acute rheumatic fever, even if symptoms resolve earlier 1, 3

What NOT to Use

Avoid these interventions that lack efficacy or increase harm:

• No local antibiotics or antiseptics - most sore throats are viral and these lack efficacy data 2, 6
• No zinc gluconate - conflicting efficacy results with increased adverse effects 1, 2
• No herbal treatments or acupuncture - inconsistent evidence and unreliable data 1, 2
• No routine corticosteroids - only consider in adults with 3-4 Centor criteria when used with antibiotics 1, 2
• No biomarkers (CRP, procalcitonin) - not necessary for routine assessment 1

Key Rationale for Antibiotic Restriction

Antibiotics do NOT prevent complications in low-risk patients:

• No benefit for preventing rheumatic fever or glomerulonephritis in patients without prior history 1
• No benefit for preventing suppurative complications (quinsy, otitis media, cervical lymphadenitis, mastoiditis, sinusitis) 1
• Most acute sore throats are viral and resolve spontaneously within days 6, 7, 8

Common Pitfalls to Avoid

• Do not prescribe antibiotics based on symptoms alone without clinical scoring or testing - this drives unnecessary antibiotic use and resistance 6, 8
• Do not assume all throat pain requires antibiotics - the vast majority are self-limiting viral infections 6, 7, 8
• Do not use broad-spectrum antibiotics like amoxicillin-clavulanate as first-line therapy - this increases resistance without additional benefit 4
• Do not stop treatment early - complete the full 10-day course when antibiotics are indicated to prevent rheumatic fever 1, 3

Special Considerations

In children under 3 months:

• Maximum dose is 30 mg/kg/day divided every 12 hours due to immature renal function 3
• Treatment duration remains at least 10 days for streptococcal infections 3

The Centor criteria work better in adults than young children due to different clinical presentations in early childhood 1, 4