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Sore throat - acute - Management
What advice should I give?

  • Reassure the individual that a sore throat is generally self limiting, with most immunocompetent people recovering after 7 days with or without antibiotic treatment.
  • Advise the person to see a healthcare professional if they do not improve. Explain that they should seek urgent medical attention if they develop any difficulty breathing, stridor, drooling, a muffled voice, severe pain, dysphagia, or if they are not able to swallow adequate fluids or become systemically very unwell.
  • Advise regular use of paracetamol or ibuprofen to relieve pain and fever.
  • Provide advice regarding food and drink to avoid exacerbating pain (e.g. avoid hot drinks).
  • Suggest the use of simple mouthwashes (e.g. warm salty water) at frequent intervals until the discomfort and swelling subside.
  • Discuss the role of antibiotics (see Prescribing an antibiotic).
  • If the person is immunosuppressed:
    • If they are taking a disease-modifying anti-rheumatic drug (DMARD) or carbimazole, tell them to stop this while waiting for the result of a full blood count (FBC). Arrange to contact them later with the result and explain that you will seek specialist advice.
    • Stress that they should seek immediate medical advice if they become systemically unwell.
    • Explain to all other people who are immunosuppressed that you will seek urgent specialist advice. This includes people who:
      • Have leukaemia, aplastic anaemia, asplenia or HIV/AIDS.
      • Are on chemotherapy or who are taking an immunosuppressive drug following a transplant. Advise them not to stop their medication unless after your discussion with the specialist they are advised to do so.
Clarification / Additional information
  • Other self care advice:
    • Adults or older children may find sucking throat lozenges, hard boiled sweets, ice, or flavoured frozen desserts (such as ice lollies) to provide additional symptomatic relief.
    • Encourage adequate fluid intake to avoid dehydration if fever is present.
Basis for recommendation
  • These recommendations are based on pragmatic advice and guidance issued by Scottish Intercollegiate Guidelines Network (SIGN), the National Clinical Systems Improvement, National Institute for Health and Clinical Excellence (NICE) and the Royal College of Paediatrics and Child Health (RCPCH) [SIGN, 1999; RCPCH, 2000; ICSI, 2007; NICE, 2007; NICE, 2008a].
  • Most throat infections are caused by viruses and are self limiting. Many do not require antibiotic therapy [DH and SMAC, 1998; MeReC, 2006; BNF 54, 2007]. There is evidence to indicate that one of the principle reasons for people with sore throat to visit their doctors is for reassurance.
  • Systemic analgesics:
    • Oral analgesics are recommended for the symptomatic relief of sore throat [MeReC, 1999; SIGN, 1999; RCPCH, 2000; MeReC, 2006]. A systematic review found systemic analgesics (paracetamol, nonsteroidal anti-inflammatory drugs, aspirin) to be helpful in relieving symptoms of sore throat [Thomas et al, 2000]. There is some evidence to indicate that, for short-term use (7 days), paracetamol and ibuprofen are equally well tolerated and both are better tolerated than aspirin.
  • Local analgesics:
    • Local analgesics are licensed for the symptomatic relief of sore throat. However, the evidence for flurbiprofen lozenges and benzydamine gargle are poor. CKS found no good evidence to support their use.

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