Educate Patients on Soothing Sore Throats, When to Seek Medical Care

Pharyngitis, commonly known as a sore throat, can negatively affect productivity and quality of life depending on the cause and severity of discomfort and pain. For individuals experiencing a sore throat, finding immediate relief is a top priority. Identifying the underlying cause is also important to determine the best treatment.

Pharmacists can guide patients in the proper selection of OTC products to relieve sore throat pain. They can also help ascertain whether self-treatment is appropriate and direct patients to seek further medical evaluation and care when warranted.

Patients complaining of a sore throat may present with symptoms such as difficulty swallowing and dry or scratchy sensation, irritation, pain, swelling, or tenderness in the throat.¹ Patients may also experience erythematous and/or swollen tonsils, fever, headache, a general feeling of malaise, and white patches in the throat or tonsils.¹

The CDC indicates that most sore throats are caused by bacterial or viral infections.² Data show an estimated 50% to 80% of sore throats are viral.³ Examples of other causes are allergies and chronic postnasal drip; excessive coughing and/or voice straining; exposure to environmental irritants such as chemicals, pollution, or smoke; gastroesophageal reflux disease; mononucleosis; strep throat; and tonsillitis.

Recent News

Research shows that sore throat is also associated with COVID-19 infection. Recent findings from the ZOE Health Study—a joint effort by investigators at Massachusetts General Hospital, Stanford University School of Medicine, the Harvard T.H. Chan School of Public Health, King’s College London, and the health application ZOE—indicated that sore throat is becoming a dominant symptom of COVID-19 infection, with fever and loss of smell becoming less commonly reported symptoms.⁴ For this study, investigators developed the COVID-19 symptom study app, which is part of the world’s largest COVID-19 study. Throughout the pandemic, investigators have used data from the app to track changes in symptoms.

Study results published in the journal Diagnosis indicated that the epidemiological burden of throat symptoms has significantly changed since the advent of Omicron variant, with a lesser risk of chemosen sory dysfunction and a greater risk of throat involvement.⁵ Additional study results in the Journal of Internal Medicine showed that the Omicron variant predominantly affects the upper airways and causes acute laryngitis without olfactory dysfunction.

Self-Treatment

Treatment for sore throat is contingent on cause, patient medication profile, and medical history. Although most mild to moderate sore throats resolve without management, several OTC products are marketed for the relief of sore throat pain. These products may contain a local anesthetic such as benzocaine or dyclonine hydrochloride, which provide temporary relief.⁷ Nonprescription products are formulated as lozenges, throat drops, and throat sprays and may be used every 2 to 4 hours as needed. Some products contain local antiseptics, such as cetylpyridinium chloride, hexylresorcinol, camphor, and menthol.¹

During counseling, pharmacists should remind patients with a history of allergies to local anesthetics to avoid products that contain benzocaine or other local anesthetics.⁷ They should also remind patients to use products as directed and seek medical care if a sore throat persists for several days or worsens. If no contraindications or drug-drug interactions are present, some physicians may recommend taking an analgesic such as acetaminophen or a nonsteroidal anti-inflammatory drug to ease pain.⁷ Nonpharmacological options include cold liquids, gargling with salt water, humidifiers, hydration, ice chips, ice pops, and warm tea with honey or lemon.⁷

Direct patients to seek medical care if they have difficulty swallowing, ear pain, fever, headaches, hoarseness lasting longer than 2 weeks, a lump in the neck, nausea, rash, severe sore throat that persists for several days despite treatment with OTC products, shortness of breath, swollen glands, vomiting, wheezing, or thick nasal or respiratory secretions that are not clear.^1,7

Conclusion

Self-treatment should be limited to mild and moderate sore throat pain when deemed appropriate. When used as directed, OTC products can provide an effective and swift onset of action and temporary relief from sore throat pain. When considering use of OTC products for children, remind caregivers and parents to use OTC products marketed only for children and to contact their pediatricians or pharmacists for guidance when in doubt. Those with persistent or severe sore throat pain and/or signs of infection should always be encouraged to seek further medical evaluation and treatment. To avoid the unnecessary prescribing of antibiotics, individuals presenting with signs of strep throat should seek medical care to confirm a diagnosis so appropriate antibiotic treatment can be initiated if warranted.

References

1. Sore throats. ENT Health. Updated February 2020. Accessed November 9, 2022. https://entnet.org/content/sore-throats

2. Sore throat. CDC. Updated October 6, 2021. Accessed No-vember 9, 2022. https://www.cdc.gov/antibiotic-use/sore-throat.html#:~:text=Of%20these%2C%20infections%20from%20viruses,(also%20called%20Streptococcus%20pyogenes)

3. Wolford RW, Goyal A, Belgam Syed SY, Schaefer TJ. Pharyn-gitis. In: StatPearls. StatPearls Publishing; 2022-. Accessed November 17, 2022. ttps://www.ncbi.nlm.nih.gov/books/NBK519550/

4. Carbajal E. Sore throat becoming most common COVID-19 symptom. Becker’s Hospital Review. October 7, 2022. Accessed November 15, 2022. https://www.beckershospi-talreview.com/public-health/sore-throat-becoming-most-common-covid-19-symptom.html

5. Nocini R, Henry BM, Mattiuzzi C, Lippi G. Evolution of throat symptoms during the COVID-19 pandemic in the US. Diagnosis (Berl). 2022;9(4):485-490. doi:10.1515/dx-2022-0084

6. Piersiala K, Kakabas L, Bruckova A, Starkhammar M, Cardell LO. Acute odynophagia: a new symptom of COVID-19 during the SARS-CoV-2 Omicron variant wave in Sweden. J Intern Med. 2022;292(1):154-161. doi:10.1111/joim.13470

7. Scolaro K. Disorders related to cold and allergy. In: Krinsky D, Berardi R, Ferreri S, et al, eds. Handbook of Nonprescrip-tion Drugs. 20th ed. American Pharmacists Association; 2021.© Iuliia / Adobe Stock

About the Author

Yvette C. Terrie, BSPharm, RPh, is a consulting pharmacist and medical writer in Haymarket, Virginia.