What is the recommended treatment for a sore throat in a pregnant woman?

Treatment of Sore Throat in Pregnancy

Acetaminophen (paracetamol) is the preferred first-line medication for symptomatic relief of sore throat pain and fever in pregnant women, combined with saline gargles for local relief. 1

Symptomatic Relief Approach

First-Line Safe Options

• Acetaminophen should be used at the lowest effective dose for the shortest possible duration to minimize fetal exposure while providing adequate pain and fever control. 1, 2
• Saline gargles provide safe and effective local symptomatic relief without any fetal risk and should be recommended as an adjunctive measure. 1, 3
• Saline nasal rinses can address associated nasal congestion or postnasal drip contributing to throat discomfort. 1, 4

Important Acetaminophen Caveats

While acetaminophen remains the safest analgesic option during pregnancy, emerging evidence suggests potential risks with prolonged or excessive use. Pregnant women should be counseled to use acetaminophen only when medically indicated, avoid long-term use without physician consultation, and use the minimum effective dose for the shortest time necessary. 5, 2 Some research has raised concerns about neurodevelopmental effects and, rarely, prenatal ductus arteriosus closure with prolonged use, particularly after the sixth month of pregnancy. 6

When Antibiotics Are Indicated (Bacterial Tonsillitis)

First-Line Antibiotic Treatment

• Penicillin G or ampicillin are the preferred antibiotics for confirmed bacterial tonsillitis due to their narrow spectrum and established safety profile throughout pregnancy. 1, 3
• For patients with non-anaphylactic penicillin allergy, first-generation cephalosporins (such as cefazolin) are the recommended alternative. 1, 3

Alternative Antibiotics

• Clindamycin or erythromycin can be used if bacterial susceptibility is confirmed. 3
• Vancomycin may be considered when susceptibility testing is unavailable or isolates show resistance to other options. 3

Medications to Strictly Avoid

Absolutely Contraindicated

• Oral decongestants must be avoided, especially during the first trimester, due to associations with fetal gastroschisis, small intestinal atresia, and maternal hypertension. 1, 3, 4
• Aspirin is contraindicated throughout pregnancy (Category D) due to risk of premature ductus arteriosus closure, intrauterine growth restriction, and perinatal mortality. 7
• Tetracyclines, aminoglycosides, trimethoprim-sulfamethoxazole, and fluoroquinolones should be avoided due to fetal risks. 1, 3

Medications to Use With Caution

• First-generation antihistamines should be avoided due to their sedative and anticholinergic properties. 7, 4

Adjunctive Therapies for Associated Symptoms

• Intranasal corticosteroids (budesonide, fluticasone, or mometasone) are safe during pregnancy and can address associated nasal symptoms or rhinitis that may contribute to throat discomfort. 1, 3, 4
• These should be used at the lowest effective dose for the shortest duration necessary. 4

Critical Timing Considerations

• The first trimester carries the highest teratogenic risk, requiring particular caution with any medication use during weeks 1-12 of pregnancy. 1, 3, 4
• Medication decisions should weigh maternal symptom severity against gestational age-specific fetal risks. 1
• For severe infections or complications, consultation with obstetrics is advisable to coordinate care. 1, 3

Clinical Pitfalls to Avoid

• Do not withhold acetaminophen when truly needed for pain or fever control, as untreated maternal fever poses its own fetal risks—but counsel patients on judicious use. 2
• Avoid prescribing combination cold medications that may contain contraindicated oral decongestants. 1, 4
• Do not assume all throat lozenges are unsafe—some have been studied in pregnancy without increased malformation risk, though data remain limited. 8
• Ensure bacterial infection is confirmed or highly suspected before initiating antibiotics rather than treating presumed viral pharyngitis. 3