Oral analgesics

Paracetamol or ibuprofen can provide rapid and effective relief of pain in sore throat. Aspirin is rarely used nowadays because of the increased risk of adverse effects. A systematic review showed no benefit of adding other analgesics. 

Patients can be advised to take the analgesic regularly to sustain pain relief. Although NICE found that no studies were identified regarding paracetamol and ibuprofen in children with sore throat, it noted that these medicines have well-established efficacy and safety profiles for managing pain and fever in the young.

Taking analgesics regularly at the recommended dosage interval is likely to be more helpful than waiting for the pain to build up again.

Medicated lozenges and pastilles

Lozenges and pastilles are commonly used OTC treatments for sore throats. Their main purpose is to soothe and moisten the throat. Based on evidence and experience, NICE states that “people may wish to try self-care with medicated lozenges (containing a local anaesthetic, a NSAID or an antiseptic agent) to help reduce pain in acute sore throat, but should be told that the benefit is likely to be small”. 

Flurbiprofen lozenges are licensed for sore throat in adults and children aged 12 years and over. They contain 8.75mg of flurbiprofen (a non-steroidal anti-inflammatory drug) and one lozenge is sucked or dissolved in the mouth every three to six hours as required, to a maximum of five lozenges. Flurbiprofen lozenges can be used for up to three days at a time. 

Lozenges containing cetylpyridinium chloride have been shown to have some antibacterial action. Local anaesthetic lozenges will numb the tongue and throat and can help to ease soreness and pain. Benzocaine can cause sensitisation and such reactions have sometimes been reported.

NICE found no evidence on non-medicated lozenges, mouthwashes or on local anaesthetic mouth sprays (without an antiseptic). Lozenges may persist longer in the throat than sprays or gargles, so may be more effective for symptom relief. Local anaesthetics (e.g. benzocaine and lidocaine) are available in throat sprays.

Benzydamine 

Benzydamine is an anti-inflammatory agent that is absorbed through the skin and mucosa and has been shown to be effective in reducing pain and inflammation in conditions of the mouth and throat. Side-effects have occasionally been reported and include numbness and stinging of the mouth and throat. 

Benzydamine spray can be used in children under 12 years of age, whereas the mouthwash may only be recommended for adults and children over 12 years.