'Painkillers best option for sore throats' say new NHS guidelines

Friday January 26 2018

"Doctors should not prescribe 'precious' antibiotics for most people with sore throats and should recommend drugs like paracetamol, new guidelines say," BBC News reports.

Antibiotics are medicines used to treat infections caused by bacteria. Respiratory tract infections like coughs, colds and sore throats are the most common reason for prescribing antibiotics.

But many of these infections are caused by viruses rather than bacteria – and neither need nor respond to antibiotics. The body can often fight these infections by itself if a person is otherwise healthy.

Over the years, using antibiotics in the wrong way has allowed some bacteria to become resistant to them. This has made them less effective in treating some serious bacterial infections.

Increasing antibiotic resistance means we could reach a point where even simple infections or surgical procedures could become hazardous.

This makes it important to only use antibiotics for the situations when they're really needed, and to use them in the right way.

Most sore throats clear up by themselves. In the majority of cases, antibiotics won't help with a sore throat.

If you have a sore throat, there are a number of ways you can help yourself.

Paracetamol can help with the pain, and gargling with warm, salty water may help shorten the infection (but this isn't recommended for children).

In most cases, you only need to see your GP if your sore throat doesn't improve after a week.

What are the common causes of sore throats?

Sore throats occur as a result of infection and inflammation in one or more parts of the upper airways. This can include pharyngitis and tonsillitis.

Either bacteria or viruses can be the cause, but in most cases the infection isn't serious and will clear up in a week or so without the need for antibiotics.

It's better to take medicines such as paracetamol to address symptoms like pain, and to rest and drink lots of fluids to stay well hydrated.

In a small number of cases, a sore throat may be part of a more serious illness.

If the person has a high fever, the sore throat has lasted longer than a week, or they're someone who might not be able to fight it off by themselves (such as people who have problems with their immune system), it's best to see a doctor.

What evidence did the guidelines look at?

The guidelines were published by the National Institute for Health and Care Excellence (NICE). NICE provides national guidance and advice to improve health and social care.

NICE looked for evidence of how effective a range of medicines were at treating sore throats, including antibiotics, painkillers and lozenges.

The best type of study to find out if something is effective is a randomised controlled trial.

If these aren't available, observational studies may be used, or recommendations can be made on the basis of the experience of a panel of expert healthcare professionals and patients.

NICE found oral painkillers such as aspirin, paracetamol and the anti-inflammatory diclofenac provided pain relief compared with placebo (dummy treatments).

But aspirin and diclofenac potentially have side effects, leading the committee to recommend paracetamol for pain relief, with ibuprofen as an alternative option.

It also found medicated lozenges that contain benzocaine, hexylresorcinol or flurbiprofen reduced pain, but only by a small amount. The side effects were rare and mild.

There was no evidence to evaluate the effectiveness of non-medicated lozenges, sprays or mouthwashes.

Corticosteroids were found to reduce the duration of pain by about 14 to 48 hours, but there was no benefit in terms of how long people were off work or school, or whether their symptoms recurred.

There was too little information on adverse effects to be sure they were worth using overall.

And a number of studies showed that overall, antibiotics reduced sore throat symptoms by around 16 hours over the course of 7 days.

There was mixed evidence as to whether antibiotics would prevent complications.

The committee also noted the risk of antibiotics having side effects, such as nausea and adverse reactions (like an allergy to penicillin).

What recommendations does NICE make?

NICE recommends that most people with a sore throat don't need to take antibiotics.

They suggest people seek medical help if symptoms worsen significantly or don't get better after a week, or they become very unwell.

NICE highlighted the following ways of managing symptoms:

  • managing any associated fever with paracetamol
  • managing pain using paracetamol or, if preferred and suitable, ibuprofen
  • avoiding dehydration by drinking enough fluids
  • being aware that it's normal for a sore throat to last around a week before clearing up, regardless of whether the cause was bacterial or viral

The guidelines noted that medicated lozenges could be tried alongside the above, but may only reduce the pain by a small amount.

There was no evidence to support the use of non-medicated mouthwashes or lozenges, or local anaesthetic mouth sprays.

Although there was some evidence that corticosteroids may reduce pain, the guidelines don't recommend using them as there wasn't enough evidence about their safety in this context.

A tool called the FeverPAIN score can be used to help doctors make decisions about who might benefit from antibiotics.

A person with a sore throat scores one point for each of the following criteria:

  • fever (during previous 24 hours)
  • purulence (pus on tonsils)
  • they feel the need to attend a GP or other doctor rapidly (within 3 days after onset of symptoms)
  • severely inflamed tonsils
  • no cough or coryza (inflammation of mucus membranes in the nose)

People who score 0 or 1 aren't likely to benefit from antibiotics at all.

For a score of 2 or 3, a doctor may choose between not prescribing and giving advice to come back if symptoms worsen, or giving a "back-up" prescription that should only be filled if symptoms don't improve after a week.

People who score 4 or 5 are most likely to benefit from an immediate antibiotic prescription, but that doesn't mean one will automatically be given – the doctor will take into account other factors, too.

People who are very unwell with symptoms of a more serious illness or condition, or who are at high risk of complications, are also likely to be given an immediate antibiotic, or in some cases may need hospital admission.


Although it's OK to seek advice from your GP if you have a sore throat, be aware that you probably won't be prescribed antibiotics unless in specific circumstances.

Most sore throats will clear up by themselves, but there are steps you can take yourself to ease the symptoms.

Pharmacists can offer advice without having to make an appointment, and this may be the quickest way for you to get support.

If you're prescribed antibiotics, it's important to take the full course, even if you start to feel better.

This will make sure you get fully better, and the bacteria that caused the illness aren't exposed to a low dose of antibiotics that they may become resistant to.

Analysis by Bazian
Edited by NHS Choices