Open Source Apothecary At Home / Breathing and airways

Sore throat

Most sore throats are viral. Honey, salt and sage are the useful measures, and antibiotics rarely change anything.

remedy

Most sore throats are viral, resolve in about a week, and are treated symptomatically. The interesting evidence is that the simple measures work better than the reputation suggests.

Honey has randomised trial evidence for soothing a sore throat and reducing cough, above one year of age. It must not be given to an infant under 12 months.

Sage has small trials for sore throat and pharyngitis, including as a spray, showing reduced pain. Combined with salt in a gargle it is a reasonable household measure.

Salt-water gargle. Soothing and cheap; it does not treat infection and it does reduce discomfort.

Topical anaesthetic sprays and lozenges reduce pain briefly and can sensitise the mouth with repeated use.

Antibiotics. Most sore throats are viral, and even in confirmed streptococcal infection antibiotics shorten the illness by only about a day while carrying the risks of resistance and allergy. Antibiotics are indicated where there is a specific concern: scarlet fever features, a very unwell patient, a high fever with exudate and no cough in a young person, or someone at risk of rheumatic fever or with immunosuppression. That is a clinical decision, not a household one.

The red flags are the point of this page. A sore throat that stops the person swallowing their own saliva, causes drooling, muffles the voice, causes difficulty breathing, or comes with a one-sided severe swelling is a deep neck infection — a peritonsillar abscess or epiglottitis — and it is an emergency. So is a sore throat with a stiff neck and a rash, which suggests meningitis.

Recurrent tonsillitis is assessed for the pattern rather than treated with another rinse — frequent documented episodes are what justify a specialist conversation.

What the studies found

Preparation

Sage and salt gargle

• 1-2 g dried sage (or 2-3 fresh leaves) infused in 250 mL boiling water for 10 minutes, strained
• Add 1/4 teaspoon of salt and let it cool to comfortably warm
• Gargle 30 seconds and spit; do not swallow
• Up to 3-4 times daily

Honey

• 1-2 teaspoons, alone or in a warm (not boiling) drink
• No honey under 12 months of age. Infant botulism.
• Above that age it is the best-evidenced simple measure for throat pain and cough

Salt water alone

• 1/2 teaspoon of salt in a glass of warm water; gargle and spit

Warm fluids

• Tea, broth, and warm water with lemon; hydration helps regardless of what is in the cup

Topical anaesthetics

• Lozenges or sprays containing a local anaesthetic give brief relief
• Repeated use can sensitise the mouth. Use sparingly.

What does not help

• Antibiotics for a viral sore throat, which is most of them
• Vitamin C at onset

When antibiotics are genuinely considered

• Scarlet fever features: a red sandpapery rash with a strawberry tongue
• A very unwell patient, or immunosuppression
• High fever with tonsillar exudate and no cough, in a young person
• A history of rheumatic fever
• These are clinical decisions. A clinician may also use a rapid strep test.

Recurrent tonsillitis

• Documented episodes (frequency, severity, time off work or school) are what justify a specialist referral
• Not another rinse

Cautions and interactions

• No honey under 12 months of age.
• Do not use topical anaesthetic lozenges repeatedly — sensitisation and, at high dose in a child, methaemoglobinaemia.
• Do not give aspirin to a child or teenager with a fever or viral illness.
• Antibiotics for a viral sore throat cause more harm than good.
• Do not use essential oils neat in the mouth — they burn the mucosa.

When this is not a self-care problem — get help

• Difficulty swallowing saliva, drooling, a muffled voice, difficulty breathing, or a severe one-sided throat swelling — emergency care; deep neck infection or epiglottitis.
• A sore throat with a stiff neck, a rash that does not fade under pressure, a severe headache or drowsiness — emergency care; possible meningitis.
• A swollen neck or jaw with fever and difficulty opening the mouth — urgent assessment.
• A sore throat lasting more than 2 weeks, or with a lump in the neck or weight loss — assessment.
• A sore throat in someone immunosuppressed — medical assessment rather than home care.

Related

• Coughs and colds: honey, zinc, and the honest list
• Influenza and when it is serious
• Fever: what it is for, and when it means something else
• Mouth and teeth: the herbal rinses and the fluoride question

Sources

1. Budesonide nasal irrigation for chronic rhinosinusitis: a meta-analysis of therapeutic outcomes and safety profile. Rhinology 2025; doi:10.4193/Rhin24.349 PubMed 39729039
2. Effect of peri-intubation non-pharmacological interventions on postoperative laryngeal symptoms: A systematic review with meta-analysis and meta-regression. Intensive & critical care nursing 2024; doi:10.1016/j.iccn.2024.103728 PubMed 38861781
3. Effectiveness of honey for symptomatic relief in upper respiratory tract infections: a systematic review and meta-analysis. BMJ evidence-based medicine 2021; doi:10.1136/bmjebm-2020-111336 PubMed 32817011
4. Saline irrigation for allergic rhinitis. The Cochrane database of systematic reviews 2018; doi:10.1002/14651858.CD006821.pub3 PubMed 29932206
5. Saline irrigation for chronic rhinosinusitis. The Cochrane database of systematic reviews 2016; doi:10.1002/14651858.CD011995 PubMed 27115216