First, because it’s what almost nobody expects to hear: the antibiotic is not the answer to your sore throat. Between 75% and 80% of acute throat infections are viral, and in an adult, group A beta-haemolytic streptococcus — the only bacterium that matters here — accounts for only 5% to 15% of cases. What works is a well chosen painkiller, a local anaesthetic or anti-inflammatory if the pain is severe, and patience: most cases resolve on their own in three to five days.
It’s worth understanding why this isn’t resignation. Even in the cases that are streptococcal and do get an antibiotic, the reduction in the intensity and duration of symptoms is under 24 hours. The antibiotic is prescribed to prevent rheumatic fever and suppurative complications, and to cut transmission, not to make it hurt less.
How to tell if it’s viral
You don’t need to be a doctor to recognise the pattern. Some signs point clearly to a virus and others suggest strep.
| Points to a virus | Points to strep |
|---|---|
| Cough | Absence of cough |
| Mucus and sneezing | Abrupt onset |
| Hoarseness | High fever (over 38 °C) |
| Conjunctivitis | Tender neck glands |
| Mouth ulcers or sores | Patches or exudate on the tonsils |
| Diarrhoea | Petechiae on the palate |
| Under 3 years of age | Headache and abdominal pain |
The criteria in the right-hand column are essentially the Centor and McIsaac scores doctors use. But be careful not to over-read them: Spain’s Guía-ABE warns that even with very high scores the probability of streptococcal infection does not exceed 50-65%. They help decide who should get a rapid test, not who has the infection. And the recommendation is explicit: an antibiotic should not be prescribed on clinical criteria alone without a microbiological test.
Translated to your case: if you have a cough, mucus and a hoarse voice, the chance that an antibiotic will do anything for you is remote.
What genuinely relieves it
Here there are options with real backing, ordered from the simplest to the most specific.
Oral painkillers. Paracetamol or ibuprofen are the foundation. They control pain and fever, and they’re the first thing MedlinePlus (US National Library of Medicine) recommends. One safety point that still bears repeating: acetylsalicylic acid is not given to children or adolescents, because of the risk of Reye’s syndrome.
Warm salt water gargles. Half a teaspoon — about 3 grams of salt — in a glass of warm water, several times a day. It cures nothing, but it soothes, costs pennies and interacts with nothing.
Fluids, and cold or warmth, whichever suits you. Warm infusions, water, ice lollies. Honey in an infusion is a reasonable option in adults and older children, but never under 12 months: Spain’s AESAN expressly advises against honey in that age group because of the risk of infant botulism.
Flurbiprofen 8.75 mg lozenges. This is the option with the most specific evidence for acute sore throat. According to the technical data sheet authorised by the AEMPS, the first perception of relief arrives on average at 13 minutes, maximum pain reduction at 70 minutes, and the effect lasts up to about 4 hours. You suck one lozenge every 3-6 hours, a maximum of 5 in 24 hours and a maximum of 3 days. It is a non-steroidal anti-inflammatory with all that entails: not indicated under 12 years old, contraindicated in the third trimester of pregnancy and in anyone who has reacted to acetylsalicylic acid or other NSAIDs. Don’t combine it with another oral NSAID.
Benzydamine spray or gargle. A locally acting anti-inflammatory, indicated for symptomatic relief of pain and inflammation of the mouth and throat. The usual spray regimen is 2 to 6 applications a day, and continuous treatment should not exceed 7 days without medical supervision. The mouthwash solution is not used under 12 years old, although some presentations are indicated from age 6.
Lozenges with no active ingredient. They stimulate saliva and lubricate the lining. That’s a real effect, though modest and brief. They help; don’t expect more than what they are.
What doesn’t work
- Antibiotics “just in case”. In a clearly viral illness they shorten nothing, while they do disturb your microbiota and contribute to resistance. Throat infection is one of the leading reasons for inappropriate antibiotic use.
- Keeping the box of antibiotics from last time. Neither the indication nor the dose nor the duration can be extrapolated from one episode to another.
- Amoxicillin-clavulanate as a first option. Even if the infection is streptococcal, it isn’t indicated: group A strep does not produce beta-lactamases. The treatment of choice is penicillin.
- Routine mouth antiseptics. A chlorhexidine mouthwash does not treat a throat infection; that isn’t what it’s for.
- Doubling the painkiller dose. It doesn’t relieve more and it multiplies the risk. With prolonged painkiller use, headache induced by the painkiller itself can also appear.
Some combinations worth avoiding
If you’re going to take flurbiprofen lozenges, bear in mind:
- Don’t add them to ibuprofen, naproxen or another oral NSAID.
- Take care if you take anticoagulants, antiplatelet drugs, oral corticosteroids or SSRI antidepressants: all of them raise the risk of gastrointestinal bleeding combined with an NSAID.
- Alcohol increases that same risk.
- They contain glucose and sucrose, worth knowing if you’re managing your blood sugar.
When to seek advice
Seek medical attention — and don’t wait until tomorrow if the first three appear — if you notice:
- Difficulty breathing, drooling, or being unable to swallow your own saliva.
- Very severe pain on one side only, with the uvula pushed across or an inability to open your mouth: this may be a peritonsillar abscess.
- Stiffness or painful swelling on one side of the neck together with a high fever.
- A high fever of abrupt onset with patches and no cough or mucus at all: this warrants a rapid strep test.
- Pain that doesn’t improve at all in 5-7 days or that worsens after having got better.
- A sandpaper-like skin rash, a very red tongue, or peeling skin.
- Generalised swollen glands and marked, prolonged tiredness: this may be glandular fever.
- Any sore throat if you are immunosuppressed, have a history of rheumatic fever, or are on drugs that lower your defences.
And a practical rule: if you’ve started a prescribed antibiotic and you’re no better at 72 hours, go back. Don’t change it yourself.
This information is general guidance only and does not replace assessment by a healthcare professional. For persistent or alarming symptoms, consult your doctor or pharmacist. Sources: Guía-ABE, Acute pharyngitis (v.2.0/2025) · AEMPS/CIMA, technical data sheet for flurbiprofen 8.75 mg lozenges · AEMPS/CIMA, technical data sheet for benzydamine oromucosal spray · MedlinePlus (NIH), Pharyngitis and sore throat · SESCAM, Acute pharyngotonsillitis: who do I prescribe antibiotics to? · AESAN, Report on infant botulism