Analgesics in Throat Medicine 

A sore throat, or pharyngitis, is a common symptom of many different conditions. An estimated 11 million people in the U.S. are diagnosed with pharyngitis in emergency departments and ambulatory settings each year.¹ It can be caused by many different conditions. Throat medicine can treat the symptom of a sore throat, while additional treatment depends on what is causing it. Throat medicine contains multiple components, with one common type of active ingredient being analgesics.  

Sore throats can have infectious or noninfectious causes, with viruses (such as influenza, herpes simplex virus, and coronavirus) accounting for the majority of infection-induced sore throats. The most common bacterial cause of pharyngitis is Group A β-hemolytic streptococcus (GABHS), or “strep throat.” Up to 30% of sore throats in children are caused by GABHS. Noninfectious causes of sore throat include allergies, gastroesophageal reflux disease (GERD), irritation from smoke or dry air, and muscle strain.²  

Despite the many causes of a sore throat, there are widely applicable options for relieving pain or discomfort.³ . Home remedies are widely used and often helpful, such as medicated lozenges containing non-steroidal anti-inflammatory drugs (NSAIDs) and soothing ingredients like menthol, or throat-coat teas containing compounds like marshmallow root, which is thought to loosen mucous and inhibit bacteria.⁴ 

For individuals with fever as well as sore throat, medicines that are combined analgesics and antipyretics, like acetaminophen (Tylenol), may be beneficial for the throat and the fever.^3,5 Other over-the-counter pain relief options include ibuprofen (Advil or Motrin), which is a non-steroidal anti-inflammatory drug (NSAID).⁵ In patients with GABHS, NSAIDs have been shown to relieve sore throat pain better than acetaminophen and are recommended by the Infectious Diseases Society of America per 2012 guidelines.⁶ For example, a randomized controlled trial conducted at 21 primary care centers showed that moderate doses of NSAIDs were more effective than acetaminophen and placebo in reducing fever, pain, and pain with swallowing (odynophagia).⁷ However, not all patients should take ibuprofen, such as those with kidney or heart diseases.⁷ 

Analgesics can reduce throat pain but may not address its root cause, with patients potentially needing other medicine as well. In confirmed diagnoses of GABHS, the antibiotic penicillin is commonly used due to its low cost, narrow activity spectrum, and effectiveness.¹ It is important to note that antibiotics are not a first-line treatment for acute sore throat. One study found that many patients often fail to self-manage acute sore throat with acetaminophen, increasing the likelihood that general practitioners may prescribe antibiotics on the assumption that the patient has already used such pain relief methods.⁸ Sore throats should not be treated with antibiotics for the prevention of suppurative complications (such as quinsy or acute mastoiditis) unless a diagnosis of bacterial infection has been confirmed. ³ Improper use of antibiotics can result in unnecessary complications and contribute to bacterial resistance.⁸ 

Though throat medicine that contains analgesics is effective at relieving discomfort, patients may find other strategies beneficial to include. For example, post-nasal drip, a common effect of allergies and irritants in the air, causes mucus from the sinuses to irritate the throat. Treatments that promote hydration while thinning mucus are effective — anything from humidifiers to oral decongestants like pseudoephedrine to chicken soup (or other hot liquids that thin mucus) — can provide relief. In the case of allergies, reducing the allergen through cleaning and air filtration will help target the irritant directly.⁹ For GERD-related throat discomfort, identifying and avoiding triggers of reflux is an initial first step for treatment. With relatively simple interventions, most patients can overcome sore throats with self-monitored treatment. 

References 

1. Choby BA. Diagnosis and treatment of streptococcal pharyngitis. Am Fam Physician. 2009;79(5):383-390. Accessed July 29, 2023. https://www.aafp.org/pubs/afp/issues/2009/0301/p383.html 

2. Weber R. Pharyngitis. Prim Care. 2014;41(1):91-98. doi:10.1016/j.pop.2013.10.010 

3. ESCMID Sore Throat Guideline Group, Pelucchi C, Grigoryan L, et al. Guideline for the management of acute sore throat. Clin Microbiol Infect. 2012;18 Suppl 1:1-28. doi:10.1111/j.1469-0691.2012.03766.x 

4. Sendker J, Böker I, Lengers I, et al. Phytochemical characterization of low molecular weight constituents from marshmallow roots (Althaea officinalis) and inhibiting effects of the aqueous extract on human hyaluronidase-1. J Nat Prod. 2017;80(2):290-297. doi:10.1021/acs.jnatprod.6b00670 

5. Ayoub SS. Paracetamol (acetaminophen): A familiar drug with an unexplained mechanism of action. Temperature (Austin). 2021;8(4):351-371. doi:10.1080/23328940.2021.1886392 

6. Shulman ST, Bisno AL, Clegg HW, et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis. 2012;55(10):e86-102. doi:10.1093/cid/cis629 

7. Little P, Moore M, Kelly J, et al. Ibuprofen, paracetamol, and steam for patients with respiratory tract infections in primary care: pragmatic randomised factorial trial. BMJ. 2013;347(oct25 2):f6041. doi:10.1136/bmj.f6041 

8. De Vocht K, Debie T, Bastiaens H, Anthierens S. The use of paracetamol for first-line treatment of acute sore throat. A descriptive generic qualitative study of GPs and patients. Eur J Gen Pract. 2021;27(1):60-67. doi:10.1080/13814788.2021.1912730 

9. Shmerling RH. Treatments for post-nasal drip. Harvard Health. Published May 14, 2022. Accessed July 29, 2023. https://www.health.harvard.edu/staying-healthy/treatments-for-post-nasal-drip