What medication can be given to an adult or child with a sore throat?

Medication for Sore Throat

For symptomatic relief of acute sore throat in both adults and children, either ibuprofen or paracetamol (acetaminophen) are recommended as first-line therapy, with ibuprofen showing slightly superior pain relief particularly after the first 2 hours. 1

Primary Analgesic Options

Ibuprofen

• Provides marginally better pain relief than paracetamol for sore throat, especially after 2 hours of administration 2, 3
• Demonstrated significantly superior efficacy compared to paracetamol across all pain rating scales in controlled trials of tonsillopharyngitis 3
• Adult dosing: Start with 400 mg every 6-8 hours, can increase to 600 mg every 6 hours if needed, maximum 2.4 g daily 2
• Safe and well-tolerated when used at over-the-counter doses for short-term treatment 4
• Has the lowest gastrointestinal complication risk among NSAIDs 5

Paracetamol (Acetaminophen)

• Equally effective as first-line option, though slightly less potent than ibuprofen for pain relief 1
• Adult dosing: 1000 mg every 6 hours, maximum 4 g in 24 hours 2, 6
• Fewer gastrointestinal side effects compared to NSAIDs 2
• Preferred in patients with contraindications to NSAIDs 2

Combination Therapy

• If paracetamol alone provides inadequate relief, add ibuprofen rather than increasing paracetamol dose 2
• Can use both medications together: paracetamol up to 4 g daily plus ibuprofen up to 2.4 g daily for severe symptoms 2

Clinical Decision Algorithm

Choose paracetamol as first-line if patient has:

• Chronic kidney disease or reduced creatinine clearance 2
• History of gastrointestinal bleeding or peptic ulcer disease 2
• Heart failure or cardiovascular disease 2
• Cirrhosis (NSAIDs contraindicated due to renal and bleeding risks) 2

Choose ibuprofen as first-line if:

• No contraindications exist and more rapid/effective pain relief is desired 1, 2
• Patient requires anti-inflammatory effects 7

For children:

• Both ibuprofen and paracetamol are equally safe and effective in single-dose studies 1
• Critical exception: Never use ibuprofen in children with chickenpox due to increased risk of severe bacterial skin infections 8
• Never use aspirin in children due to Reye syndrome risk 8

Medications NOT Recommended

Zinc Gluconate

• Not recommended for sore throat treatment due to conflicting efficacy data and increased adverse effects 1

Corticosteroids

• Not routinely recommended for sore throat 1
• May be considered only in adults with severe presentations (3-4 Centor criteria) in conjunction with antibiotics 1
• No evidence of benefit in children 1

Herbal Treatments and Acupuncture

• Insufficient reliable evidence to recommend these therapies 1

Important Safety Considerations

Common pitfalls to avoid:

• Do not exceed maximum daily doses: paracetamol >4 g/24 hours risks hepatotoxicity; ibuprofen >2.4 g/24 hours increases adverse events 2
• Do not use NSAIDs without assessing renal function, particularly in older adults and those with heart failure 2
• For patients at high gastrointestinal risk requiring NSAIDs, consider adding proton pump inhibitor for gastroprotection 2
• Use lowest effective dose for shortest duration to minimize adverse events 5

Duration of symptoms:

• Acute sore throat is typically self-limiting with mean duration of 7 days regardless of treatment 7
• Symptomatic treatment helps control discomfort during this period 7