Best Medication for Sore Throat
For symptomatic relief of sore throat, ibuprofen is the first-line medication of choice, showing superior efficacy compared to paracetamol (acetaminophen), particularly after 2 hours of administration. 1, 2
Symptomatic Treatment Algorithm
First-Line Analgesics
Ibuprofen is the preferred systemic analgesic for acute sore throat, providing effective pain relief with a low risk of adverse effects when used according to directions for short-term treatment 3, 1, 2
Paracetamol (acetaminophen) serves as an effective alternative when ibuprofen is contraindicated or not tolerated, though clinical trials demonstrate ibuprofen has slightly better efficacy for pain relief 2, 4
Both medications are considered safe for short-term use, with equivalent safety profiles 3, 2
Adjunctive Local Anesthetics
Local anesthetics can be added for additional symptomatic relief, including lidocaine (8mg), benzocaine (8mg), or ambroxol (20mg) as lozenges, throat sprays, or gargles 1, 5
Among local anesthetics, ambroxol (20mg) has the best documented benefit-risk profile 5
When to Consider Antibiotics
Risk Stratification Using Centor Criteria
The decision to use antibiotics depends on clinical probability of group A streptococcal infection using the Centor scoring system (fever, tonsillar exudates, tender anterior cervical lymphadenopathy, absence of cough): 3, 2, 6
0-2 Centor criteria (low risk): Do NOT prescribe antibiotics - antibiotics provide no meaningful benefit and should not be used to relieve symptoms 3, 2, 7
3-4 Centor criteria (high risk): Consider antibiotics only after discussing modest benefits versus risks with the patient, including side effects, impact on microbiota, antimicrobial resistance, and costs 3, 2, 7
Antibiotic Selection (If Indicated)
Penicillin V is the first-choice antibiotic, given twice or three times daily for 10 days 3, 2, 7
Clarithromycin serves as an alternative for penicillin-allergic patients 6
Treatment duration should be 5-7 days minimum, though 10 days is recommended for penicillin V 3, 6
Critical Pitfalls to Avoid
What NOT to Use
Do NOT recommend local antibiotics or antiseptics - these lack efficacy data and most sore throats are viral in origin 1, 2, 5
Do NOT recommend zinc gluconate - conflicting efficacy results and increased adverse effects make this inappropriate 1, 2, 7
Do NOT recommend herbal treatments or acupuncture - lack of reliable data supporting efficacy 1, 2, 7
Common Misconceptions About Antibiotics
Antibiotics do NOT prevent suppurative complications (quinsy, otitis media, sinusitis, mastoiditis) in most cases 7
Antibiotics do NOT prevent rheumatic fever or glomerulonephritis in low-risk patients without prior rheumatic fever history 7
Even when indicated, antibiotics provide only modest symptom relief (shortening duration by approximately 1 day), which must be weighed against harms 3, 6
Special Considerations
Patients with Renal Impairment
Paracetamol is the safer choice over ibuprofen due to potential NSAID risks in renal impairment 7
Paracetamol dosing does not require adjustment for mild-to-moderate renal impairment 7
Severe Presentations
Corticosteroids can be considered in conjunction with antibiotic therapy for severe presentations (3-4 Centor criteria) in adults, using single low-dose oral dexamethasone (maximum 10mg) 2
Corticosteroids are NOT routinely recommended and should only be used after discussing modest benefits versus risks 2