A sore throat is characterised by a dry, scratchy pain in the throat when swallowing. It can be caused by several conditions including a viral or bacterial infection (also known as a cold) and generally does not need medical treatment. However, a bacterial infection can be serious. A typical viral sore throat usually lasts up to seven days. Individuals between the ages of 5 to 24 are most likely to get a sore throat, especially during the early spring or winter months (Rughani, 2019). Sometimes a sore throat can be severe enough to cause the airway to swell. In these instances, the person should access medical care.
Guidelines
- Paracetamol can reduce the pain caused by a sore throat. **
- Drinking a hot drink may relieve the pain. *
- Medicated lozenges (containing benzocaine, hexylresorcinol or flurbiprofen) or mouth sprays (containing chlorhexidine gluconate and benzydamine hydrochloride) may relieve the pain. *
- Antibiotics should only be given if prescribed by a medical professional. *
Good practice points
- Nonsteroidal anti-inflammatory drugs (such as ibuprofen) can be used as a second-line treatment for sore throat, should paracetamol be ineffective.
- The first aid provider should encourage the person to drink water in small amounts.
- Harsh or high-pitched breathing sounds, the inability to swallow, severe pain or drooling are signs and symptoms of potential airway swelling that should receive urgent medical care.
- If a first aid provider suspects the person has a swollen airway, they should help the person rest in a comfortable position and access medical care.
Chain of survival behaviours
Prevent and prepare
- Avoid people who are sick with an infectious illness such as the flu or strep throat.
- Wash your hands with soap and water or use hand sanitizer to prevent the spread of the common cold (Allan & Arroll, 2014).
- Avoid smoking and smoky environments.
Early recognition
A person with a sore throat may:
- complain of a painful or dry, scratchy throat, especially when swallowing
- have swollen neck glands, redness at the back of the throat, swollen tonsils or whitish spots in the throat
- experience difficulty eating and drinking.
The person may also have pain in their ear, see Earache or Fever. Children in particular may experience vomiting or Abdominal pain.
First aid steps
- Advise the person to take the recommended dose of paracetamol to relieve their pain.
- Encourage the person to drink lots of water in small amounts. A hot drink may relieve their pain.
- Consider advising the person to take medicated lozenges or mouth spray to soothe their throat.
Access help
- The first aid provider should access medical care if someone with a sore throat:
> has difficulty breathing
> also experiences fever, dehydration, a painful neck or a rash
> is not able to drink
> has severe pain
> does not see any improvements after multiple days
> is unable to manage any secretions (e.g., drooling)
> develops an earache
> experiences a sore throat frequently.
Education considerations
Context considerations
- It can be difficult for people to identify the cause of a sore throat (viral, bacterial or environmental). Early actions, such as giving the ill person a drink, can help to eliminate some causes and help the learner to identify if the condition is more serious.
- Encourage learners to look for other signs and symptoms, and to consider causes, such as whether the person has been near another person who has a cold or flu, as this will help to inform treatment.
- In some contexts, local pharmacies can provide advice and treatment if the cause is viral and help identify if the cause is more serious and requires medical attention.
- Follow your national regulations on who can administer non prescribed painkillers as their regulations overrule these guidelines.
Facilitation tips and tools
- Pictures which illustrate signs of more serious medical conditions can be helpful for learners to understand if the person needs medical treatment.
- Emphasise that while most sore throats are usually not serious, they may be a symptom of a more severe condition and learners must recognise the situations in which to access medical care.
- Draw connections to other topics within first aid when exploring sore throat such as recognising signs of a serious illness, assessment skills (e.g., asking about the history of the person’s symptoms). (See General approach.)
Scientific foundation
Systematic reviews
We identified four relevant evidence reviews on this topic, one by the British National Institute for Health and Care Excellence (NICE), two systematic reviews, and two evidence summaries from the Centre for Evidence-Based Practice (CEBaP).
Medication options
For their guideline on acute sore throat, NICE performed an evidence review that included self-care interventions to relieve the symptoms, such as paracetamol or ibuprofen, medicated lozenges and mouth sprays (2018).
No systematic reviews or randomised controlled trials were identified that compared non-medicated lozenges, non-medicated mouthwashes or any other non-pharmacological interventions with placebo or another intervention in people with acute sore throat.
Three randomised controlled trials found that aspirin, paracetamol and diclofenac potassium were all more effective than placebo at improving pain and reducing fever in adults with an acute sore throat, although it’s not clear whether the improvements were clinically meaningful (low- to moderate- certainty evidence).
Results from six randomised controlled trials found statistically significant improvements in pain scores with medicated lozenges (containing benzocaine, hexylresorcinol or flurbiprofen) compared with placebo, although the absolute improvements were small and may not be clinically meaningful for some lozenges (low- to moderate-certainty evidence). In one randomised controlled trial that provided evidence on the effectiveness of a chlorhexidine gluconate and benzydamine hydrochloride mouth spray, the intensity of the clinical signs was statistically significantly decreased, and the reported health state was statistically significantly improved. No differences were observed in their quality of life (moderate- to high-certainty evidence).
A CEBaP evidence summary from 2020 on the use of paracetamol in case of sore throat identified eight randomised controlled trials. It was shown that paracetamol resulted in a statistically significant decrease of pain intensity (when swallowing), and a statistically significant increase in pain relief and change in the swollen throat, compared to placebo. A statistically significant change of sore throat (ordinal outcome), sore throat or time point or spontaneous pain, using paracetamol compared to placebo, could not be demonstrated in two studies. Evidence is of moderate certainty and results cannot be considered precise due to limited sample size and/or lack of data.
The Cochrane review (Spinks, 2013) determined that antibiotics can be used to treat a sore throat. While most people usually recover within five to seven days, some develop complications. A severe (but rare) complication is rheumatic fever, affecting the heart and joints. Additionally, antibiotics reduce the duration of strep throat symptoms (streptococcal infection) by an average of one to two days. However, these medications can also cause diarrhoea, a rash and other unfavourable side effects, and communities can build a resistance to them. The review concluded that the benefits do not outweigh the multiple and at times serious, side effects. The NICE guideline states additionally that antibiotics do not help throat pain caused by a virus (NICE, 2018).
Non-medication options
A CEBaP evidence summary found limited evidence in favour of consuming a hot drink (CEBaP, 2020). One uncontrolled before and after study showed that having a hot drink resulted in a statistically significant decrease in the symptoms of sore throat. A statistically significant decrease in symptoms of a sore throat when having a drink at room temperature, could not be demonstrated. Evidence is of very low certainty and results cannot be considered precise due to limited sample size and lack of data.
Non-systematic reviews
Limited evidence states that frequently gargling with warm water and salt may help to reduce episodes of upper respiratory tract infection (Allan and Arroll, 2014).
We also reviewed two papers on the condition epiglottis, a type of airway swelling, that has decreased over the last 20 years because of immunisation; however, it is still prevalent in un-immunised populations. Unimmunised people are at risk: children, people in areas with no immunisations, people over 45 with outdated immunisations. Inflammation of the epiglottis and surrounding tissues can lead to a narrowing of the airway and produce specific stridor (high-pitched, abnormal breathing sounds). People with epiglottis could initially have a sore throat, fever and breathing difficulty. They also characteristically do not have a cough. First aid providers should help the person to take the position in which they are most comfortable and help them access medical care immediately (Lindquist et al., 2017; Adil et al., 2015).
References
Systematic reviews
Centre for Evidence-Based Practice, Belgian Red Cross-Flanders. (2020). Evidence summary Sore throat – Drinking hot or cold drinks. Available from: https://www.cebap.org/knowledge-dissemination/first-aid-evidence-summaries/
Centre for Evidence-Based Practice, Belgian Red Cross-Flanders. (2020). Evidence summary Sore throat – Paracetamol. Available from:
https://www.cebap.org/knowledge-dissemination/first-aid-evidence-summaries/
Del Mar, C. B., Glasziou, P. P., & Spinks, A. B. (2001). Antibiotics for sore throat. Cochrane Database of Systematic Reviews, 2.
Lal A, Chohan K, Chohan A, Chakravarti A. (2017). Role of honey after tonsillectomy: a systematic review and meta-analysis of randomised controlled trials. Clinical Otolaryngol. Jun;42(3):651-660. DOI 10.1111/coa.1279
National Institute for Health and Care Excellence. (2018). Sore throat (acute): antimicrobial prescribing guideline. Evidence review; January, 2018; Retrieved from https://www.nice.org.uk/guidance/ng84/evidence/evidence-review-pdf-4723224013
Spinks, A., Glasziou, P. P., & Del Mar, C. B. (2013). Antibiotics for sore throat. Cochrane Database of Systematic Reviews, (11).
Non-systematic reviews
Adil EA, Adil A, Shah RK. (2015). Epiglottitis. Clinical Pediatric Emergency Medicine. 16 (3): 149-153.
Allan GM, Arroll B. (2014). Prevention and treatment of the common cold: making sense of the evidence. Canadian Medical Association Journal; 186 (3) : 190-199.
Lindquist B, Zachariah S, Kulkarni A. (2017). Adult epiglottitis: A case series. Perm J., (21) : 16-089.
Rughani S. (2019). Case-based learning: sore throat. The Pharmaceutical Journal, Sept; 303 (7929); [online]
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