From the Guidelines
For a sore throat, the next step should be to start with self-care measures and consider a rapid strep test if symptoms persist or worsen, with antibiotics like penicillin V or amoxicillin prescribed only if strep throat is diagnosed. The management of a sore throat depends on its severity and duration. For mild cases, self-care measures are recommended, including:
- Rest
- Staying hydrated
- Gargling with warm salt water (1/4 to 1/2 teaspoon of salt in 8 ounces of warm water)
- Using throat lozenges
- Taking over-the-counter pain relievers like acetaminophen (Tylenol) 650mg every 6 hours or ibuprofen (Advil, Motrin) 400-600mg every 6-8 hours as needed, as suggested by 1
- Honey mixed in warm tea can also provide relief
If symptoms persist beyond 7 days, worsen significantly, are accompanied by fever over 101°F (38.3°C), difficulty swallowing or breathing, or if you have a compromised immune system, seek medical attention promptly. A healthcare provider may perform a rapid strep test to check for bacterial infection, using the Centor clinical scoring system or rapid antigen test to target antibiotic use, as recommended by 1. If strep throat is diagnosed, antibiotics like penicillin V (250-500mg twice daily for 10 days) or amoxicillin (500mg twice daily for 10 days) are typically prescribed, as suggested by 1 and 1. Most sore throats are viral and will resolve on their own within a week, but bacterial infections require proper treatment to prevent complications like rheumatic fever or kidney inflammation. Antibiotics should not be used in patients with less severe presentation of sore throat, as the benefits are modest and there are potential side effects and risks of antibacterial resistance, as noted by 1 and 1.
From the Research
Sore Throat Diagnosis and Treatment
- The diagnosis of sore throat involves a physical examination, patient history, and diagnostic methods such as clinical scoring systems, rapid antigen detection tests, and throat culture 2.
- The modified Centor score can be used to help physicians decide which patients need no testing, throat culture/rapid antigen detection testing, or empiric antibiotic therapy 3, 4.
- Clinical guidelines recommend the use of penicillin or amoxicillin as first-line treatment for Group A beta-hemolytic streptococcal (GABHS) pharyngitis 3, 4.
Antibiotic Treatment
- Antibiotics are only indicated in cases of bacterial pharyngitis, which accounts for less than 35% of cases 5.
- The use of clinical scores such as the Centor, McIsaac, or FeverPAIN score can help assess the risk of bacterial pharyngitis and guide antibiotic treatment 5, 4.
- Penicillin is the first choice for antibiotic treatment, with clarithromycin as an alternative 5.
- The antibiotic should be taken for 5-7 days 5.
Symptomatic Treatment
- Patients should be encouraged to use self-management techniques such as ibuprofen and naproxen for symptomatic treatment 5.
- Nonsteroidal anti-inflammatory drugs are more effective than acetaminophen and placebo for treatment of fever and pain associated with GABHS pharyngitis 4.
- Medicated throat lozenges used every two hours are also effective in relieving symptoms 4.