Professional Documents
Culture Documents
Farrer F, BPharm
Amayeza Info Centre
Abstract
A sore throat is a common complaint, and often an early indication of another medical condition, such as a cold. In the
absence of life-threatening conditions or bacterial infection, local symptomatic treatment will ease the pain. This article
reviews the common causes and symptoms of sore throats, and provides an overview of some of the sprays and lozenges
that are available to treat this problem.
© Medpharm Reprinted with permission from S Afr Pharm J 2011;78(4):26-31
enlarged lymph glands and pus-like exudate on the throat been shown to have a higher initial deposition of active
membranes.6 Patients who present with unusually severe ingredient in the mouth and throat, and slower rates
symptoms such as difficulty swallowing, drooling, or neck of clearance, compared with throat sprays and rinses.
swelling should be referred for further evaluation.7 This suggests that lozenges may have a more sustained
effect in the symptomatic treatment of pharyngitis. They
Treatment
may be a choking hazard in young children, and should
In the absence of an underlying medical problem, most sore not be used in children under the age of three or four
throats will resolve without treatment, but generally patients years.1,2,8
seek some form of symptomatic relief.2 Although there is a
Alternative or non-medical therapies
preconception that patients wish to obtain antibiotics for a
sore throat, studies have indicated that this is not the case. In some cases, e.g. small children, medicated products may
not be suitable. Other home remedies may provide relief of
The three most important reasons for a patient asking
a sore throat.
for assistance to treat a sore throat were reported to be:
to establish the cause of the symptoms, to obtain pain These measures include:1,2,6
relief, and to discover the possible duration of symptoms. • Increased fluid intake assists in keeping the mucus thin
Patients who considered antibiotic therapy to be essential and in mucus clearance.
thought that pain relief was very important, and believed • Home-made gargles with warm salt water may ease
that antibiotics were necessary to achieve it faster.8 pain, but are not suitable for small children.
Systemic therapy • Honey and lemon juice in warm water soothes pain and
loosens thick mucus secretions.
Systemic therapy may include antimicrobial agents, • Cold beverages and ice cream are particularly popular
analgesics and anti-inflammatory agents: with small children, and provide some relief from dryness
• Antimicrobials: Antibiotic therapy is indicated for patients and irritation.
with bacterial pharyngitis or tonsillitis. Antibiotics help to
prevent further spread of the infection, and to reduce Available products
the risk of complications. However, antibiotics are not Oral rinses and gargles are commonly used, not only for throat
effective for throat pain that is caused by viral infections.1 pain, but also for oral hygiene. Disinfectant and anaesthetic
• Analgesics: Systemic analgesics may be useful in ingredients, such as benzydamine, cetylpyridinium chloride
treating moderate-to-severe throat pain. Paracetamol and benzocaine, are useful in the treatment of stomatitis,
or nonsteroidal anti-inflammatories (NSAIDs) such as gingivitis and mouth ulcers.1, 9
ibuprofen, may alleviate throat pain, as well as resolve
fever or inflammation. Aspirin should be avoided in Throat sprays containing local anaesthetics, such as
children under the age of 16 years due to the risk of benzocaine, and disinfectants, e.g. chlorhexidine gluconate
Reye’s syndrome.1 and phenol, are available to treat sore throats.1,9 Lozenges
• Glucocorticoids: Glucocorticoids may play a role in the containing analgesics or anaesthetics, e.g. benzydamine
treatment of throat pain and swelling associated with HCl and benzocaine, and/or antiseptic or disinfectant
certain infections.1,8 agents, such as cetylpyridinium chloride and dichlorobenzyl
alcohol, are available for symptomatic relief of throat pain.
Topical therapy
The demulcent or moisturising effects of sucking the
Topical therapies include oral rinses (gargles), sprays and lozenger may be responsible for the effectiveness of these
lozenges. Advantages of topical therapies include direct preparations. Throat lollies are available for smaller children.
application of pain relief to the area of inflammation, and However, they are not recommended for infants.1,8,9
decreased risk of toxicity, when compared to systemic
Active ingredients
administration.
• Oral rinses: Oral rinses are effective in coating the oral Active ingredients in throat sprays and lozenges aim to
cavity and the base of the tongue. provide symptomatic relief of pain. Some have disinfectant
• Sprays: Throat sprays are effective in coating the properties to decrease the likelihood of further infection.
posterior pharynx. Throat sprays are not recommended Disinfectants such as amylmetacresol, cetylpyridinium
for use in children under the age of six years. Cl, chlorhexidine gluconate, dichlorobenzyl alcohol, and
• Lozenges: A variety of lozenges are available for the phenol are antibacterial. Phenol is bacteriostatic against
treatment of throat pain and dryness. Lozenges have Gram-positive and Gram-negative bacteria. Cetylpyridinium
Table I: Properties of active ingredients8-10 Table III: Throat lozenges and their active ingredients9
a choking hazard. The possibility also exists that because 5. Sore throat. Mayo Clinic. [homepage on the Internet]. c2011. Available from:
http://www.mayoclinic.com/health/sore_throat/DS00526
boiled sweets can effect some relief from a dry throat, 6. Mims, over-the-counter. 2008.
that all throat lozenges, including medicated lozenges, are 7. Bisno A. Evaluation of acute pharyngitis in adults. [homepage on the Internet].
“throat sweets”. With this idea in mind, patients may think c2011. Available from: www.uptodate.com
8. Stead W. Symptomatic treatment of acute pharyngitis in adults. [homepage on
that it is safe to suck a lozenge when needed, without paying
the Internet]. c2011. Available from: www.uptodate.com
any attention to the dosing information. Patients must be 9. Mims, 2010. Vol 50 (6).
reminded that all medicated products are “medicine”. 10. Reynolds JEF (ed). Martindale. 29th ed. London: The Pharmaceutical Press; 1989.