From the Guidelines
If your throat hurts, the first step is to try home remedies such as drinking plenty of warm fluids, gargling with salt water, and taking over-the-counter pain relievers like acetaminophen or ibuprofen, as most sore throats are viral and resolve within 5-7 days with these measures. When considering the management of acute sore throat, it's essential to note that the European Society for Clinical Microbiology and Infectious Diseases recommends using the Centor clinical scoring system or rapid antigen test to target antibiotic use 1. The Centor scoring system helps identify patients with a higher likelihood of group A streptococcal infection, and in such cases, a rapid antigen test (RAT) can be considered. If a RAT is performed, throat culture is not necessary after a negative RAT for the diagnosis of group A streptococci 1. For relief of acute sore throat symptoms, either ibuprofen or paracetamol is recommended, while zinc gluconate is not recommended 1. Antibiotics should not be used in patients with less severe presentation of sore throat, and if indicated, penicillin V is recommended, twice or three times daily for 10 days 1. More recent guidelines suggest that pharyngitis has predominantly a viral origin, and treatment ranges from no antibiotic treatment, delayed antibiotic treatment, or treatment based on microbiological testing results, with penicillin and amoxicillin being effective for group A streptococcal pharyngitis 1. However, the most recent and highest quality study, which is from 2024, recommends penicillin as the first-line antibiotic for acute sore throat, with cephalexin as a second-line option 1. Some studies have compared the efficacy of different antibiotics, including cephalosporins and macrolides, but the differences in efficacy are not clinically significant, and penicillin remains the treatment of choice due to its proven efficacy, safety, narrow spectrum, and low cost 1. It's crucial to seek medical attention if symptoms persist or worsen, especially in individuals with compromised immune systems or chronic conditions. Key points to consider when managing a sore throat include:
- Using home remedies such as warm fluids, salt water gargling, and over-the-counter pain relievers
- Seeking medical attention if symptoms persist or worsen
- Using the Centor scoring system or rapid antigen test to target antibiotic use
- Considering penicillin as the first-line antibiotic for acute sore throat, with cephalexin as a second-line option.