Commentary

Sore throat is one of the most common conditions managed in primary care. Irrespective of the cause and whether antibiotics can be targeted to prevent complications,^{1, 2} patients require help with symptoms. The review by Thomas et al is important in bringing together a diverse range of evidence for non-antibiotic management, particularly given current concerns about resistance and the marginal effectiveness of antibiotics for the symptoms of sore throat in most patients.²

These data suggest that paracetamol, aspirin, and other NSAIDs are effective, although there is no evidence that NSAIDs—with their greater side effects—are more effective than paracetamol alone.³ Vaccination and α streptococcal spray may also help, although the practicalities and cost effectiveness of such interventions are unclear. Some care is also required in interpreting the data: the estimates of treatment effect are relative and refer to diverse outcomes (pain severity, symptom resolution, and recurrence), and most studies were not done in typical primary care settings.

Clearly, more evidence is needed in primary care settings about the safety and effectiveness of non-antibiotic treatments. Nevertheless, these data should give doctors confidence that, on the basis of current evidence, non-antibiotic treatments are probably at least as effective as if not more effective than antibiotic treatment for the symptoms of sore throat.