Supportive Therapy for Sore Throat
Either ibuprofen or paracetamol (acetaminophen) should be used as first-line treatment for symptomatic relief of acute sore throat, with ibuprofen providing slightly superior pain relief. 1, 2, 3
Primary Analgesic Recommendations
Ibuprofen is the preferred first-line systemic analgesic for acute sore throat based on high-quality evidence showing better efficacy than paracetamol, particularly at 2 hours post-administration. 2, 3 Both medications are safe for short-term use with low risk of adverse effects when used according to directions. 3
- Ibuprofen: Provides more effective pain relief than paracetamol, especially in the first few hours after administration 2, 3
- Paracetamol (Acetaminophen): Acceptable alternative with equivalent safety profile 1, 3
- Both reduce throat soreness and headache symptoms by day 3, though 82% of untreated patients are symptom-free by one week regardless 4
What NOT to Use
Avoid these interventions as they lack efficacy or have unfavorable risk-benefit profiles:
- Zinc gluconate: Not recommended due to conflicting efficacy results and increased adverse effects 1, 3
- Local antibiotics or antiseptics: Should not be used due to mainly viral origin of sore throats and lack of efficacy data 3, 5
- Herbal treatments and acupuncture: Inconsistent evidence and insufficient reliable data supporting efficacy 1, 2, 3
Corticosteroids: Limited Role
Corticosteroids are NOT routinely recommended for sore throat treatment. 1, 3 They can be considered only in adult patients with severe presentations (3-4 Centor criteria) when used in conjunction with antibiotic therapy, using single low-dose oral dexamethasone (maximum 10 mg). 1, 2, 3 For patients with 0-2 Centor criteria, corticosteroids should not be used. 3
Local Anesthetics: Evidence-Based Options
If patients specifically request local therapeutics, three local anesthetics have confirmed efficiency in clinical trials:
- Lidocaine 8 mg 5
- Benzocaine 8 mg 5
- Ambroxol 20 mg (best documented benefit-risk profile among local anesthetics) 5
These can be recommended as first-line local treatment options. 5
Clinical Context and Symptom Timeline
The modest benefit of any intervention must be understood in context: antibiotics reduce sore throat symptoms at day 3 (number needed to treat = 6), but by one week the number needed to treat increases to 18 because most cases resolve spontaneously. 4 Headache is reduced at day 3 with analgesics, but fever reduction at day 3 is not statistically significant. 4
Common Pitfalls to Avoid
- Do not prescribe antibiotics empirically without clinical assessment, as over 60% of adults with sore throat receive unnecessary antibiotics 2
- Do not use systemic antibiotics for symptom relief in patients with less severe presentations (0-2 Centor criteria) 1, 3
- Do not recommend complementary or alternative therapies lacking evidence-based support 2