Sore throat in children and adolescents: Symptomatic treatment
- Jan E Drutz, MD
Jan E Drutz, MD
- Section Editor — General Pediatrics
- Professor of Pediatrics
- Baylor College of Medicine
Symptomatic relief of sore throat in children and adolescents will be reviewed here. The evaluation of sore throat in children, the diagnosis and differential diagnosis of group A streptococcal tonsillopharyngitis in children, and the symptomatic treatment of sore throat in adults are discussed separately. (See "Evaluation of sore throat in children" and "Group A streptococcal tonsillopharyngitis in children and adolescents: Clinical features and diagnosis" and "Symptomatic treatment of acute pharyngitis in adults".)
CAUSES OF SORE THROAT
In children and adolescents, sore throat is usually caused by a viral infection or group A Streptococcus (table 1). Less common causes include other bacterial infections, respiratory allergies, inflammatory disease (eg, Behçet syndrome), irritant inhalants, dryness, and trauma (eg, hot liquids, foreign body injury, caustic ingestion, inhaled toxic gases). (See "Evaluation of sore throat in children", section on 'Causes'.)
Anticipatory guidance — Anticipatory guidance for sore throat in children and adolescents includes education about:
●Expected course of illness – Throat pain caused by infections usually lasts a few days and should improve steadily without worsening.
In a 2013 meta-analysis of six randomized trials and one observational study (344 children), sore throat lasted between two to seven days among children who received control, placebo, or over-the-counter treatment; sore throat resolved by day 3 in approximately 60 to 70 percent of cases . The duration of symptoms was similar in children with and without group A streptococcal (GAS) tonsillopharyngitis.
- Thompson M, Vodicka TA, Blair PS, et al. Duration of symptoms of respiratory tract infections in children: systematic review. BMJ 2013; 347:f7027.
- Bisno AL. Acute pharyngitis: etiology and diagnosis. Pediatrics 1996; 97:949.
- Spinks A, Glasziou PP, Del Mar CB. Antibiotics for sore throat. Cochrane Database Syst Rev 2013; :CD000023.
- Thomas M, Del Mar C, Glasziou P. How effective are treatments other than antibiotics for acute sore throat? Br J Gen Pract 2000; 50:817.
- Bradley CP. Taking another look at the acute sore throat. Br J Gen Pract 2000; 50:780.
- Middleton DB, D'Amico F, Merenstein JH. Standardized symptomatic treatment versus penicillin as initial therapy for streptococcal pharyngitis. J Pediatr 1988; 113:1089.
- Bisno AL. Acute pharyngitis. N Engl J Med 2001; 344:205.
- Schmitt BD. Sore throat (pharyngitis). In: Instructions for Pediatric Patients, WB Saunders, Philadelphia 1999. p.91.
- Snellman L, Adams W, Anderson G, et al. Institute for Clinical Systems Improvement. Diagnosis and treatment of respiratory illness in children an adults. Updated January 2013. https://www.icsi.org/guidelines__more/catalog_guidelines_and_more/catalog_guidelines/catalog_respiratory_guidelines/respiratory_illness/ (Accessed on August 25, 2016).
- Weglowski J. An evidence-based approach to the evaluation and treatment of pharyngitis in children. Pediatric Emerg Med Practice 2011; 8:1.
- Flurbiprofen: new indication. Lozenges: NSAIDs are not to be taken like sweets! Prescrire Int 2007; 16:13.
- Ambroxol lozenges: new drug. Sore throat: better to just suck on hard candy. Prescrire Int 2009; 18:52.
- Chenot JF, Weber P, Friede T. Efficacy of Ambroxol lozenges for pharyngitis: a meta-analysis. BMC Fam Pract 2014; 15:45.
- Questions & Answers: Reports of a rare, but serious and potentially fatal adverse effect with the use of over-the-counter (OTC) benzocaine gels and liquids applied to the gums or mouth www.fda.gov/Drugs/DrugSafety/ucm250029.htm (Accessed on August 03, 2012).
- Hopper SM, McCarthy M, Tancharoen C, et al. Topical lidocaine to improve oral intake in children with painful infectious mouth ulcers: a blinded, randomized, placebo-controlled trial. Ann Emerg Med 2014; 63:292.
- Hess GP, Walson PD. Seizures secondary to oral viscous lidocaine. Ann Emerg Med 1988; 17:725.
- Scottish Intercollegiate Guidelines Network. Management of sore throat and indications for tonsillectomy. Guideline No. 117. April 2010. http://www.sign.ac.uk/guidelines/fulltext/117/ (Accessed on August 30, 2016).
- Pierce CA, Voss B. Efficacy and safety of ibuprofen and acetaminophen in children and adults: a meta-analysis and qualitative review. Ann Pharmacother 2010; 44:489.
- Gehanno P, Dreiser RL, Ionescu E, et al. Lowest effective single dose of diclofenac for antipyretic and analgesic effects in acute febrile sore throat. Clin Drug Investig 2003; 23:263.
- Schachtel BP, Thoden WR. A placebo-controlled model for assaying systemic analgesics in children. Clin Pharmacol Ther 1993; 53:593.
- Bertin L, Pons G, d'Athis P, et al. Randomized, double-blind, multicenter, controlled trial of ibuprofen versus acetaminophen (paracetamol) and placebo for treatment of symptoms of tonsillitis and pharyngitis in children. J Pediatr 1991; 119:811.
- Benarrosh C. [Multicenter double blind study of tiaprofenic acid versus placebo in tonsillitis and pharyngitis in children]. Arch Fr Pediatr 1989; 46:541.
- Eccles R, Loose I, Jawad M, Nyman L. Effects of acetylsalicylic acid on sore throat pain and other pain symptoms associated with acute upper respiratory tract infection. Pain Med 2003; 4:118.
- Moghal NE, Hegde S, Eastham KM. Ibuprofen and acute renal failure in a toddler. Arch Dis Child 2004; 89:276.
- Feder HM. Acute pharyngitis: fitting the drug to the bug. Contemp Pediatr 2001; 18:41.
- Watson N, Nimmo WS, Christian J, et al. Relief of sore throat with the anti-inflammatory throat lozenge flurbiprofen 8.75 mg: a randomised, double-blind, placebo-controlled study of efficacy and safety. Int J Clin Pract 2000; 54:490.
- Cingi C, Songu M, Ural A, et al. Effect of chlorhexidine gluconate and benzydamine hydrochloride mouth spray on clinical signs and quality of life of patients with streptococcal tonsillopharyngitis: multicentre, prospective, randomised, double-blinded, placebo-controlled study. J Laryngol Otol 2011; 125:620.
- Cingi C, Songu M, Ural A, et al. Effects of chlorhexidine/benzydamine mouth spray on pain and quality of life in acute viral pharyngitis: a prospective, randomized, double-blind, placebo-controlled, multicenter study. Ear Nose Throat J 2010; 89:546.
- Faden H. Management of primary herpetic gingivostomatitis in young children. Pediatr Emerg Care 2006; 22:268.
- Hayward G, Thompson MJ, Perera R, et al. Corticosteroids as standalone or add-on treatment for sore throat. Cochrane Database Syst Rev 2012; 10:CD008268.
- Crawford-Faucher A. Corticosteroids for the treatment of sore throat. Am Fam Physician 2014; 89:14.
- Olympia RP, Khine H, Avner JR. Effectiveness of oral dexamethasone in the treatment of moderate to severe pharyngitis in children. Arch Pediatr Adolesc Med 2005; 159:278.
- Bulloch B, Kabani A, Tenenbein M. Oral dexamethasone for the treatment of pain in children with acute pharyngitis: a randomized, double-blind, placebo-controlled trial. Ann Emerg Med 2003; 41:601.
- Attia MW. ACP Journal Club. Review: adding corticosteroids to antibiotics improves pain relief in patients with sore throat. Ann Intern Med 2013; 158:JC11.
- Rezk E, Nofal YH, Hamzeh A, et al. Steroids for symptom control in infectious mononucleosis. Cochrane Database Syst Rev 2015; :CD004402.
- Bereznoy VV, Riley DS, Wassmer G, Heger M. Efficacy of extract of Pelargonium sidoides in children with acute non-group A beta-hemolytic streptococcus tonsillopharyngitis: a randomized, double-blind, placebo-controlled trial. Altern Ther Health Med 2003; 9:68.
- Mazzone A, Catalani M, Costanzo M, et al. Evaluation of Serratia peptidase in acute or chronic inflammation of otorhinolaryngology pathology: a multicentre, double-blind, randomized trial versus placebo. J Int Med Res 1990; 18:379.
- Thamlikitkul V, Dechatiwongse T, Theerapong S, et al. Efficacy of Andrographis paniculata, Nees for pharyngotonsillitis in adults. J Med Assoc Thai 1991; 74:437.
- Spasov AA, Ostrovskij OV, Chernikov MV, Wikman G. Comparative controlled study of Andrographis paniculata fixed combination, Kan Jang and an Echinacea preparation as adjuvant, in the treatment of uncomplicated respiratory disease in children. Phytother Res 2004; 18:47.
- Cáceres DD, Hancke JL, Burgos RA, et al. Use of visual analogue scale measurements (VAS) to asses the effectiveness of standardized Andrographis paniculata extract SHA-10 in reducing the symptoms of common cold. A randomized double blind-placebo study. Phytomedicine 1999; 6:217.
- Brinckmann J, Sigwart H, van Houten Taylor L. 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 2003; 9:285.
- Huang Y, Wu T, Zeng L, Li S. Chinese medicinal herbs for sore throat. Cochrane Database Syst Rev 2012; :CD004877.
- Frye R, Bailey J, Blevins AE. Clinical inquiries. Which treatments provide the most relief for pharyngitis pain? J Fam Pract 2011; 60:293.
- Sas D, Enrione MA, Schwartz RH. Pseudomonas aeruginosa septic shock secondary to "gripe water" ingestion. Pediatr Infect Dis J 2004; 23:176.
- Newmaster SG, Grguric M, Shanmughanandhan D, et al. DNA barcoding detects contamination and substitution in North American herbal products. BMC Med 2013; 11:222.
- Rodríguez-González M, Benavente Fernández I, Zafra Rodríguez P, et al. Toxicity of remedies for infantile colic. Arch Dis Child 2014; 99:1147.
- Wille D, Hauri-Hohl M, Vonbach P, et al. Too much of too little: xylitol, an unusual trigger of a chronic metabolic hyperchloremic acidosis. Eur J Pediatr 2010; 169:1549.
- Aviner S, Berkovitch M, Dalkian H, et al. Use of a homeopathic preparation for "infantile colic" and an apparent life-threatening event. Pediatrics 2010; 125:e318.
- CAUSES OF SORE THROAT
- GENERAL MEASURES
- Anticipatory guidance
- Treat underlying cause as indicated
- Supportive care
- SYMPTOMATIC TREATMENT
- Our approach
- - Soothing measures
- - Systemic analgesia
- - Worsening or persistent pain
- Other therapies
- - Medicated lozenges and sprays
- - Medicated oral rinses
- - Glucocorticoids
- - Alternative therapies
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS