Sore throat

What doctors say*

* Official guidelines from NICE.

Should antibiotics be used? >

Only if more than two of the following

Fever during previous 24 hours
Pus on tonsils
Tender and swollen glands on neck
Absence of cough
Symptoms severe enough to call out doctor.

Likely duration if untreated >

2-8 days

Conventional self-care advice >

Consider paracetamol for pain or fever, or if preferred and suitable, ibuprofen
Drink adequate fluids
Some evidence that medicated lozenges can help reduce pain in adults

Opportunities for antibiotic alternatives >

If less than two of the NICE criteria above

Pelargonium

> what do these ratings mean?

Systemic reviews of clinical research conclude that there is good quality evidence of the use of pelargonium in acute pharyngitis

See the evidence ...

An analysis of two systematic reviews and eight clinical trials concluded that there was qualified evidence that andrographis was useful in the treatment of upper respiratory tract infections [Kligler, 2006].

A more recent randomised controlled trial assessed changes in symptom scores among 223 patients with uncomplicated upper respiratory tract infection. In treatment with a proprietary andrographis or placebo, mean scores of all symptoms showed a decreasing trend from day 1 to day 3 but from day 3 to day 5 most of the symptoms in placebo group either remained unchanged or worsened whereas in andrographis group all symptoms showed a decreasing trend [Saxena, 2010].

References

Kligler B, Ulbricht C, Basch E, Kirkwood CD, et al (2006). Andrographis paniculata for the treatment of upper respiratory infection: a systematic review by the natural standard research collaboration. Explore (NY) 2(1): 25-9

Link to Abstract

Saxena RC, Singh R, Kumar P, Yadav SC et al (2010). A randomized double blind placebo controlled clinical evaluation of extract of Andrographis paniculate (KalmCold™) in patients with uncomplicated upper respiratory tract infection. Phytomedicine 17, 3–4, 178-185

Link to Abstract

Sage

> what do these ratings mean?

Controlled clinical trials of sage spray and proprietary sage products showed efficacy against viral pharyngitis.

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A randomised, double-blind, parallel group phase II/III study compared the efficacy and tolerability of spray (containing 15 % Salvia officinalis fluid extract) against placebo in the treatment of patients with acute viral pharyngitis. Symptomatic relief occurred within the first two hours after initial administration and was statistically significantly superior to placebo [Hubbert, 2006]. Similar benefits were also seen in a randomised controlled study on a proprietary sage product [Brinckmann, 2003].

References

Brinckmann J, Sigwart H, van Houten Taylor L. (2003) Safety and efficacy of a traditional herbal medicine (Throat Coat) in symptomatic temporary relief of pain in patients with acute pharyngitis: a multicenter, prospective, randomized, double-blinded, placebo-controlled study. J Altern Complement Med. 9 (2): 285-98

Link to Abstract

Hubbert M, Sievers H, Lehnfeld R, Kehrl W. (2006) Efficacy and tolerability of a spray with Salvia officinalis in the treatment of acute pharyngitis – a randomised, double-blind, placebo-controlled study with adaptive design and interim analysis. Eur J Med Res. 11(1): 20-6

Link to Abstract

Honey

> what do these ratings mean?

Only a little published scientific evidence, though this supports everyday experience of relief of symptoms. See tips for using propolis below.

See the evidence ...

In one review of the evidence [Oduwole, 2018], limited by the short-term use in most cases, there was low level evidence that honey relieves cough symptoms better than no treatment, placebo and the proprietary medications salbutamol and diphenhydramine, and was found to be comparable to dextromethorphan. There was no difference in occurrence of adverse events between the honey and control arms.

In an overview of honey, propolis, and royal jelly and their biological potentials the potential health benefits of honey, such as microbial inhibition, wound healing, and its effects on other diseases, are described [Pasupuleti, 2017].

References

Oduwole O, Udoh EE, Oyo‐Ita A, Meremikwu MM (2018) Honey for acute cough in children. Cochrane Database Syst Rev. 2018 (4): CD007094

Link to Abstract and Full Text

Pasupuleti VR, Sammugam L, Ramesh N, Gan SH (2017) Honey, Propolis, and Royal Jelly: A Comprehensive Review of Their Biological Actions and Health Benefits. Oxid Med Cell Longev. 1259510

Link to Abstract and Full Text

Traditional home remedies worth trying

Propolis, resins and balsams

Remedies containing resins are long-standing remedies for sore throats. Myrrh and frankincense are two biblical examples and resinous extracts of calendula, various balsams (eg balsam of Peru, balsam of Tolu, Balm of Gilead and Canada balsam) and more popularly propolis have all been used into modern times. There is no doubt that resins are antiseptic. The challenge has often been to get them in a form that can be applied as they are insoluble in anything other than high levels of alcohol or other organic solvents. However balsams are already in liquid form and are worth looking out for. It is usually safest and just as effective to use a resin solution as a gargle and then spit out rather than swallow.

See the evidence ...

Propolis has been reported to have various health benefits related to gastrointestinal disorders, allergies, and gynaecological, oral, and dermatological problems, and is established as antiseptic [Przybyłek, 2019]. A combination of propolis and zinc has been found helpful in reducing the incidence and severity of acute otitis media [Marchisio, 2010].

References

Marchisio P, Esposito S, Bianchini S, et al. (2010) Effectiveness of a propolis and zinc solution in preventing acute otitis media in children with a history of recurrent acute otitis media. Int J Immunopathol Pharmacol. 23(2): 567-75

Link to Abstract and Full Text

Przybyłek I, Karpiński TM. (2019) Antibacterial Properties of Propolis Molecules. 29;24(11)

Link to Abstract and Full Text