What actually helps a sore throat: painkillers and time, not antibiotics

The most useful thing to know about a sore throat is that it almost always clears on its own within a week, so the honest goal of treatment is to make the days it lasts less painful, not to cut it short [s1]. Painkillers such as paracetamol or ibuprofen and simple soothing measures do that; a short course of honey modestly eases the cough and irritation that often come with it [s3]. What does very little is the antibiotic many people still expect — pooled trials show it trims the duration of symptoms by only about 16 hours [s1].

The antibiotic most sore throats do not need

Sore throat is one of the most common reasons people seek care, and it is also one of the most over-treated. A Cochrane review pooled 27 trials covering 12,835 cases of sore throat to ask what antibiotics actually do [s1]. They help, but modestly: throat soreness and fever were reduced by about half, with the biggest difference at day three, and the effect had largely closed by a week [s1]. Averaged across everyone treated, antibiotics shortened the duration of symptoms by about 16 hours [s1].

The catch is how many people have to take a drug for one to benefit. The number needed to treat to prevent one ongoing sore throat was fewer than six at day three, but 21 by week one [s1]. Antibiotics did reduce some complications — acute middle-ear infection within 14 days fell (risk ratio 0.30, 95% confidence interval 0.15 to 0.58) and quinsy, a throat abscess, within two months fell sharply (risk ratio 0.15, 95% CI 0.05 to 0.47) [s1] — but those complications are now rare in high-income countries, so treating many to prevent one carries its own costs in side effects and resistance. That is the same stewardship logic behind the advice on antibiotics and the common cold and on watchful waiting for ear infections. Because most sore throats are viral, an antibiotic does nothing at all against the cause.

What eases the pain

Since the throat will heal regardless, the defensible aim is comfort. Ordinary over-the-counter analgesics — paracetamol or an anti-inflammatory such as ibuprofen — are the mainstay for the pain itself, the same painkillers weighed in coverage of NSAID kidney risk. Lozenges, warm or cold fluids, and rest are low-risk soothing measures whose value is symptomatic relief rather than any effect on the infection.

A separate Cochrane review looked at corticosteroids, usually a single dose of dexamethasone, added on top of usual care in nine trials with 1,319 participants [s2]. On top of any effect of antibiotics and painkillers, steroids increased the likelihood of complete pain resolution at 24 hours by 2.4 times (risk ratio 2.4, 95% CI 1.29 to 4.47) and at 48 hours by 1.5 times (risk ratio 1.50, 95% CI 1.27 to 1.76) [s2]. About five people need treating for one to be free of pain at 24 hours who otherwise would not be, and the mean time to complete resolution fell by 11.6 hours [s2]. That is a real but small benefit for an ordinary sore throat, and steroids are a prescription decision with their own trade-offs — not something the evidence turns into a routine self-treatment.

Honey: modest, and mostly for the cough

Honey is the folk remedy with the least embarrassing evidence behind it. A 2020 systematic review and meta-analysis of 14 studies found that, compared with usual care, honey improved a combined symptom score (mean difference −3.96, 95% CI −5.42 to −2.51), cough frequency (standardised mean difference −0.36, 95% CI −0.50 to −0.21) and cough severity (standardised mean difference −0.44, 95% CI −0.64 to −0.25) in upper respiratory tract infections [s3]. The signal is real but should not be oversold: when the review pooled the two trials comparing honey against a placebo rather than usual care, the effect was no longer statistically significant (standardised mean difference −0.63, 95% CI −1.44 to 0.18) [s3], and much of the evidence is in children's cough, the setting explored in coverage of honey for children's cough. Honey should not be given to infants under one year because of the risk of botulism [s3].

Two things worth naming for what they are not: honey is a soothing agent, not an antimicrobial cure, and the popular idea that a sore throat signals a bacterial infection needing an antibiotic is wrong most of the time — the value of remedies like zinc lozenges sits on a similarly thin footing, and much of the perceived benefit of any treatment overlaps the placebo response seen in pain trials.

When it is not just a sore throat

The reviews here concern the ordinary, self-limiting sore throat in otherwise healthy people [s1]. A throat that is severe, one-sided, or accompanied by difficulty breathing or swallowing, drooling, a muffled voice, a high fever that will not settle, or symptoms that drag on well beyond a week falls outside that picture and is a reason to seek care — as is a sore throat in someone with a weakened immune system. Whether a particular sore throat needs testing for strep, an antibiotic, or nothing at all is a clinical judgement this article does not make; the evidence simply shows that for most people, most of the time, the drug they came in asking for is the one they need least.