Analgesia or antibiotics?

Most sore throats are self-limiting and 90 per cent of patients feel better or improve within one week of the onset of symptoms, whatever the cause, with or without antibiotics. 

NICE states that, regarding sore throat, “antibiotics make little difference to how long symptoms last or the number of people whose symptoms improve”. Trust in pharmacists to make antibiotic decisions has increased in recent years and was found to stand at 71 per cent when over 2,000 adults were surveyed in a large Public Health England 2020 study. 

The same research found that about one-third of participants incorrectly believe that antibiotics effectively treat viral or fungal infections, showing that patient education remains crucial. The authors concluded that healthcare professionals need to explain the rationale for withholding antibiotics, especially to lower educational attainment and black, Asian and minority ethnic (BAME) patients, who were more likely to challenge the denial of antibiotics.

Pharmacists can offer treatment to provide some relief from discomfort and pain until the infection subsides. Oral analgesics are first-line and recommended for all patients, even those given antibiotics. A systematic review of clinical trials found that simple analgesics (paracetamol, aspirin and ibuprofen) are very effective at reducing the pain from sore throat.   

Some medicated lozenges and pastilles have a soothing effect. NICE states that “lozenges containing benzocaine, hexylresorcinol or flurbiprofen may help to reduce pain in adults”. There is also some evidence that benzydamine spray is effective in relieving sore throat pain.