What medications are safe for a pregnant individual with a sore throat?

Safe Medications for Sore Throat During Pregnancy

For a pregnant woman with a sore throat, start with saline gargles and acetaminophen for pain relief, reserving antibiotics like amoxicillin only for confirmed bacterial infections such as strep throat. 1

First-Line Safe Treatments

Non-Pharmacologic Measures

• Saline gargles and nasal rinses are the safest initial approach for sore throat and associated nasal congestion, with no risk to the developing fetus. 1

Acetaminophen for Pain and Fever

• Acetaminophen remains the preferred analgesic and antipyretic during pregnancy when medication is necessary, though emerging evidence warrants cautious use. 1
• Use the lowest effective dose for the shortest possible time, particularly avoiding long-term or high-dose exposure. 2
• While acetaminophen has been associated with potential neurodevelopmental and reproductive concerns in some epidemiological studies, it remains the safest available option when pain or fever relief is medically indicated. 2, 3
• Do not withhold acetaminophen when clinically needed, as untreated fever or severe pain poses greater risks to both mother and fetus than judicious acetaminophen use. 3

Antibiotics for Bacterial Infections

When Antibiotics Are Indicated

• Beta-lactam antibiotics (penicillins and cephalosporins) are safe throughout pregnancy for confirmed bacterial pharyngitis or tonsillitis. 1, 4
• Amoxicillin is specifically safe during pregnancy, with reproduction studies in animals showing no evidence of fetal harm at doses up to 3-6 times the human dose. 5
• Macrolides can be used but carry slightly higher risk compared to beta-lactams; avoid erythromycin and clarithromycin if alternatives exist. 4

Important Caveat

• Only use antibiotics for confirmed bacterial infections (such as positive strep test), not for viral sore throats which comprise the majority of cases. 4

Medications for Associated Symptoms

For Nasal Congestion (if present)

• Intranasal corticosteroids, particularly budesonide (Pregnancy Category B), are safe and effective for persistent nasal symptoms accompanying sore throat. 6, 1, 7
• Budesonide has the most extensive human safety data and does not increase risks of malformations, preterm delivery, or low birth weight. 7
• Avoid oral decongestants, especially in the first trimester, due to associations with congenital malformations and maternal hypertension. 1, 7
• Short-term topical nasal decongestants (maximum 7 days) may be used cautiously if absolutely necessary, but carry risk of rebound congestion. 1, 4

For Allergic Component

• Second-generation antihistamines (cetirizine or loratadine) are safe if allergic rhinitis is contributing to throat symptoms. 1, 7
• Cetirizine is particularly recommended for third trimester use. 7
• Avoid first-generation antihistamines due to sedative and anticholinergic effects. 1

Medications to Strictly Avoid

• NSAIDs (except non-selective NSAIDs before 32 weeks) should generally be avoided, particularly in late pregnancy. 1
• Aspirin is FDA Category D and contraindicated for routine pain relief during pregnancy. 1
• Oral decongestants (pseudoephedrine, phenylephrine) should be avoided in the first trimester and used with extreme caution thereafter due to associations with gastroschisis and other malformations. 1, 7

Clinical Algorithm

1. Assess severity and likely etiology: Determine if bacterial infection (strep throat) is likely based on clinical presentation
2. Start with non-pharmacologic measures: Saline gargles, adequate hydration, humidified air
3. Add acetaminophen if needed: For pain or fever control at lowest effective dose
4. Test for strep throat if indicated: Rapid strep test or throat culture for appropriate cases
5. Prescribe amoxicillin only if bacterial infection confirmed: Standard dosing for strep pharyngitis
6. Address associated symptoms: Use intranasal budesonide for significant nasal congestion, antihistamines for allergic component

Common Pitfalls to Avoid

• Do not assume all medications in the same class have equivalent safety profiles during pregnancy; specific agents within classes have vastly different safety data. 7
• The first trimester carries highest teratogenic risk; exercise particular caution with any systemic medications during organogenesis. 6, 8
• Avoid combining decongestants with acetaminophen or salicylates, as this combination increases malformation risk. 6
• Do not prescribe antibiotics empirically for viral pharyngitis, which represents the majority of sore throat cases. 4