What medication is recommended for a patient with a sore throat?

Medication for Sore Throat

Primary Recommendation

Ibuprofen or paracetamol (acetaminophen) are the first-line medications for acute sore throat, with ibuprofen showing slightly superior efficacy for pain relief. 1, 2

Treatment Algorithm

Step 1: Rule Out Red Flags and Assess Severity

• Exclude immunosuppression, severe systemic infection, or signs requiring immediate specialist referral 3
• Calculate Centor score (1 point each for: fever, tonsillar exudates, tender anterior cervical lymphadenopathy, absence of cough) 1, 4

Step 2: First-Line Symptomatic Treatment (All Patients)

Analgesics are the cornerstone of treatment:

• Ibuprofen 400 mg is preferred over paracetamol based on superior pain relief, particularly after 2 hours of administration 1, 2, 5
• Paracetamol 1000 mg is an effective alternative if ibuprofen is contraindicated 1, 2
• Both medications have low risk of adverse effects when used short-term according to directions 2
• A novel ibuprofen 25 mg lozenge formulation provides rapid relief starting at 15 minutes, though standard oral dosing remains the evidence-based standard 6

Step 3: Antibiotic Decision Based on Centor Score

Low risk (0-2 Centor criteria):

• Do NOT prescribe antibiotics for symptom relief 1, 2
• Continue analgesics only 1

Moderate risk (3 Centor criteria):

• Consider delayed antibiotic prescription strategy 3
• Discuss with patient that antibiotics provide only modest benefit (approximately 5 hours reduction in pain duration) 7

High risk (3-4 Centor criteria):

• Penicillin V for 10 days is first-line antibiotic choice 2
• Amoxicillin is an alternative beta-lactam option 8
• Clarithromycin if penicillin-allergic 3
• Treatment duration: 5-7 days minimum 3

Step 4: Corticosteroid Consideration (Selective Use Only)

Corticosteroids are NOT routinely recommended but can be considered in specific circumstances: 1, 4, 7

When to consider (adults only with 3-4 Centor criteria):

• Single dose of dexamethasone 10 mg orally alongside antibiotic therapy 4
• Provides approximately 5 hours additional symptom reduction 7
• Must discuss modest benefits versus potential risks with patient 4, 2

When NOT to use corticosteroids:

• Patients with 0-2 Centor criteria 2
• Children (no demonstrated benefit) 4
• Patients with diabetes, glucose dysregulation, or endocrine disorders 4
• Patients already on exogenous steroids 4
• Routine use in typical primary care populations where most patients lack severe presentations 4, 7

What NOT to Use

Avoid these interventions due to lack of efficacy or safety concerns:

• Zinc gluconate - not recommended (conflicting efficacy, increased adverse effects) 1, 2
• Local antibiotics or antiseptics - not recommended due to mainly viral etiology and lack of efficacy data 2, 9
• Herbal treatments or acupuncture - inconsistent evidence 1, 2

Key Clinical Pitfalls

Common mistakes to avoid:

• Prescribing antibiotics for low Centor scores (0-2) - antibiotics should NOT be used to prevent rheumatic fever or glomerulonephritis in low-risk patients 1
• Prescribing antibiotics to prevent suppurative complications (quinsy, otitis media, sinusitis) - this is NOT a specific indication 1
• Using corticosteroids routinely - the effect is considerably smaller in typical primary care where most patients lack severe presentations 4, 7
• Prescribing aspirin in children due to Reye syndrome risk 7

Expected Clinical Course

• Acute sore throat is self-limiting with mean duration of 7 days regardless of treatment 3
• Antibiotics provide only modest symptom reduction even in bacterial cases 1, 7
• Encourage patient self-management with analgesics as primary strategy 3