How to Get Rid of a Throat Infection: What Actually Works

Most throat infections clear up on their own because the vast majority are caused by viruses, which antibiotics cannot touch. Streptococcal bacteria account for only about 5–10% of sore throats in adults and 15–30% in children, meaning the real question for most people is not which antibiotic to take but how to manage symptoms while the infection runs its course. What actually works spans a surprisingly well-studied range of options, from over-the-counter painkillers to a single dose of a steroid, and knowing which to reach for can shave hours off your misery.

Why Most Throat Infections Do Not Need Antibiotics

The instinct when your throat is raw and swollen is to get a prescription. But antibiotics only meaningfully help when the culprit is group A streptococcus (GAS), commonly called strep throat. A large Cochrane review found that antibiotics were significantly more effective at relieving symptoms by day three in people whose throat swabs tested positive for strep, while the benefit largely disappeared for those with negative swabs.¹ That tracks with what we know about the underlying cause: most sore throats stem from common cold viruses, influenza, or other respiratory viruses that antibiotics simply cannot treat.²

Unnecessary antibiotic prescriptions are not just useless against viruses; they carry real downsides. Overprescribing is linked to a higher risk of side effects, more frequent return visits, and growing antibiotic resistance in the community.³ Throat infections, as one of the most common reasons for clinic visits, bear a disproportionate share of that antibiotic burden.⁴ So the first honest step in getting rid of a throat infection is figuring out whether you actually need an antibiotic at all.

How Strep Throat Gets Diagnosed (and Why It Is Harder Than You Think)

Clinicians have long used scoring systems like the Centor and McIsaac scores to estimate how likely it is that a sore throat is caused by strep. These scores tally clinical signs: fever, swollen lymph nodes in the neck, white patches on the tonsils, and the absence of a cough. A high score makes strep more likely; a low score makes it less so. But a recent systematic review and meta-analysis concluded that these scores have limited diagnostic value and are “at best marginally better than chance” at identifying GAS pharyngitis on their own.⁵ A large validation study using retail health clinic data found an area under the curve of only about 0.72 for the Centor score, which is modest.⁶

That is why most guidelines recommend confirming with a lab test rather than prescribing based on symptoms alone. The rapid antigen detection test (the quick swab you get in a clinic) is highly specific, meaning a positive result is very reliable, but its sensitivity can be inconsistent. One study found sensitivity of about 65% with a specificity around 97%.⁷ Another found that sensitivity varied from 56% to 90% depending on who performed the test, with laboratory technologists consistently outperforming non-lab personnel.⁸ In practical terms, a positive rapid test means you almost certainly have strep. A negative one is less conclusive, which is why a follow-up throat culture is sometimes recommended, especially in children.

Newer molecular tests (nucleic acid amplification, or NAAT) perform far better, with sensitivity and specificity both exceeding 95% in head-to-head comparisons with culture.⁹ These are becoming more widely available but are not yet the standard in every clinic. If you are told your rapid test is negative but your symptoms are severe, asking about a confirmatory culture or molecular test is reasonable.

When Antibiotics Are Warranted

If you do have confirmed strep, antibiotics serve two purposes: they shorten your illness somewhat, and they protect you from rare but serious complications. The modest symptom benefit in strep-positive patients, such as faster resolution of sore throat by roughly a day, has to be weighed against potential side effects and the broader impact on antibiotic resistance.¹⁰ But the complication-prevention argument is strong. A meta-analysis of older trials found that antibiotics reduced the risk of acute rheumatic fever by about 70% in people with suspected strep infections, with about 53 patients needing treatment to prevent one case.¹¹ Rheumatic fever can cause lasting heart damage, which is why the American Heart Association has long emphasized proper identification and treatment of GAS pharyngitis as the cornerstone of prevention.¹²

Standard first-line treatment for strep is penicillin or amoxicillin, typically for ten days. If you are allergic to penicillin, alternatives exist. The key point is to finish the full course even if you feel better after a few days, because incomplete treatment increases the odds of bacterial persistence and complications.

Pain Relief That Actually Shortens Your Suffering

Whether your throat infection is viral or bacterial, pain management is the treatment that makes the biggest immediate difference. Two over-the-counter options dominate: ibuprofen and acetaminophen (paracetamol). In a direct comparison using sore throat as a pain model, ibuprofen at 400 mg outperformed acetaminophen at 1000 mg on all pain-rating scales from the two-hour mark onward.¹³ Ibuprofen’s edge likely comes from its anti-inflammatory action on top of its painkilling effect, which helps with the swelling that makes swallowing painful.

That said, a meta-analysis of randomized trials looking at the common cold overall found no significant difference between NSAIDs and acetaminophen for general analgesic effect.¹⁴ The takeaway is that both work well enough if you cannot take one or the other, but when your main symptom is a severely sore throat, ibuprofen has the stronger evidence behind it. For people who can take both safely, alternating them can provide more consistent relief throughout the day.

The Steroid Shortcut

One of the most under-discussed treatments for sore throat is a single low dose of a corticosteroid, usually dexamethasone. A BMJ systematic review found that patients given a single dose (up to 10 mg of dexamethasone) were twice as likely to experience pain relief at 24 hours and about 1.5 times more likely to be pain-free at 48 hours compared to placebo. On average, the time to first pain relief arrived nearly five hours sooner, and complete resolution came about 11 hours earlier.¹⁵ A trial in children found similar results, with dexamethasone roughly halving the time to initial pain relief compared to placebo.¹⁶

Corticosteroids are not sold over the counter for this purpose, so you would need a prescription. They work by tamping down inflammation in the throat tissue, which is why the relief is dramatic even though they do not kill the underlying pathogen. Not every clinician offers them routinely for sore throat, but if your pain is severe and you ask, the evidence supports a single-dose approach as both safe and effective in otherwise healthy adults.

Topical Treatments for Targeted Relief

Lozenges and throat sprays containing a local anti-inflammatory can provide relief right at the source. Flurbiprofen 8.75 mg, available in both spray and lozenge form in many countries, has been tested in randomized trials. One study found that both formulations provided comparable pain reduction within two hours, with the spray being non-inferior to the lozenge.¹⁷ Both formats also significantly improved difficulty swallowing and throat swelling at one and two hours after use.¹⁸ If you prefer not to take a systemic painkiller, or if you want to add something on top of ibuprofen, a medicated lozenge or spray with an anti-inflammatory ingredient is a reasonable option.

Plain throat lozenges without a drug ingredient still offer mild benefit simply by stimulating saliva production, which keeps the throat moist. Menthol lozenges add a cooling sensation that many people find soothing, though the effect is sensory rather than pharmacological.

Home Remedies, Sorted by Evidence

Honey consistently shows up as a useful remedy in the research. A systematic review and meta-analysis found that honey improved combined symptom scores for upper respiratory infections compared to usual care, with particular benefits for cough frequency and severity.¹⁹ A spoonful of honey, or honey stirred into warm water or tea, coats the throat and likely has a mild anti-inflammatory and antimicrobial effect. It should not be given to children under one year old due to botulism risk.

Hot drinks are another common recommendation, and there is some evidence behind them. A study comparing a hot fruit drink to the same drink served at room temperature found that the hot version provided immediate and sustained relief from sore throat, tiredness, and chills, while the room-temperature version helped mainly with nasal symptoms.²⁰ Tea, broth, and warm water with lemon all fall into this category. The mechanism is likely a combination of increased mucus flow, soothing of inflamed tissue, and simple hydration.

Cold drinks and ice pops are the opposite approach, and they work by a different route. Cold exposure can reduce the perception of pain and may decrease muscle spasm sensitivity in the throat.²¹ There is no rule that says you must choose one or the other. Some people find hot drinks more soothing, others prefer cold; either is fine, and staying hydrated matters more than the temperature.

Saltwater gargling is perhaps the most universally recommended home remedy, but the evidence behind it is thinner than most people assume. A lab study testing various gargle formulations against SARS-CoV-2 found that a 2% saltwater solution showed zero reduction in viral load even after 60 seconds of contact.²² Saltwater is not going to kill a pathogen, but many people report that gargling temporarily eases discomfort, probably by drawing fluid out of swollen tissue through osmotic effects. It is harmless and cheap, so there is no reason to stop if it feels helpful. Just do not expect it to shorten the infection.

Herbal and Alternative Options

Marshmallow root extract is one of the few herbal remedies with at least some user-reported outcome data for throat irritation. Two surveys of users found that marshmallow-root-based preparations provided good symptomatic relief for pharyngeal irritation and associated dry cough, with most users noticing effects within ten minutes.²³ The likely mechanism is a thick mucilage that physically coats the throat, similar to honey. The evidence base here is consumer surveys rather than controlled trials, so the confidence level is lower, but the risk of harm is also extremely low.

Complications Worth Knowing About

Most throat infections resolve without drama, but a small number progress into something that needs urgent attention. A peritonsillar abscess, sometimes called quinsy, happens when infection spreads from a tonsil into the surrounding tissue and forms a pocket of pus. Classic signs include severe pain concentrated on one side, difficulty opening the mouth, fever, and a muffled or “hot potato” voice.²⁴ In children, deep neck infections can be particularly dangerous because they may obstruct the airway or spread into the chest.²⁵ If a sore throat is getting dramatically worse rather than slowly better, especially with one-sided swelling, increasing difficulty swallowing, or trouble breathing, that warrants an emergency visit rather than another day of lozenges.

Epiglottitis is another rare but life-threatening condition that often starts with what feels like a sore throat. In adults, it typically presents as severe difficulty swallowing that comes on over hours to days, sometimes with drooling, a muffled voice, and shortness of breath.²⁶ A large case series found that sore throat was the presenting symptom in 95% of adult epiglottitis cases, meaning it can initially be mistaken for ordinary pharyngitis.²⁷ The distinguishing features are rapid worsening and disproportionate difficulty swallowing relative to the degree of visible throat redness.

When a Sore Throat Is Not Really an Infection

A chronic or frequently recurring sore throat that does not come with fever, swollen glands, or other signs of infection may not be an infection at all. Acid reflux is one of the most common mimics. Laryngopharyngeal reflux, where stomach acid reaches the back of the throat, can cause persistent irritation, a scratchy feeling, and the sensation of a lump in the throat. Researchers found that reflux was significantly more common in patients with chronic nonspecific pharyngitis compared to controls, suggesting that undiagnosed reflux drives many cases of unexplained recurring throat discomfort.²⁸ If your “throat infections” keep coming back despite negative strep tests and no clear viral pattern, reflux is worth investigating. Treatment shifts entirely in that case, toward acid-suppressing medication and dietary changes rather than antibiotics or painkillers.

Tonsillectomy for Recurring Infections

If you are someone who gets strep throat several times a year, the question of removing the tonsils inevitably comes up. The classic threshold for considering tonsillectomy, known as the Paradise criteria, requires a documented history of frequent, severe, and well-documented episodes over one to three years.²⁹ In the original trial that established this standard, children who met the strict criteria and had their tonsils removed experienced significantly fewer throat infections over the following two years. But many children assigned to the non-surgical group also improved on their own, with most episodes being mild.³⁰

More recent research has pushed back on the strictness of current guidelines. A long-term outcome study found that tonsillectomy provided sustained quality-of-life improvement even in patients who did not quite meet the conventional criteria, and that the strongest predictor of benefit was how much the patient’s quality of life was impaired before surgery, not simply the number of documented episodes.³¹ The surgery is not risk-free, with complications (mostly bleeding and pain) occurring in about 14% of patients in the original trial, though all were manageable. For adults, recovery tends to be more painful and prolonged than for children.

Probiotics as a Preventive Strategy

For people prone to recurrent strep infections, there is early but intriguing evidence around oral probiotics. The probiotic strain Streptococcus salivarius K12 colonizes the mouth and throat and produces compounds that inhibit the growth of strep bacteria. In a pediatric study, children with a history of frequent strep infections saw their monthly incidence drop dramatically during a 90-day course of this probiotic.³² An adult study showed roughly an 80% reduction in strep pharyngitis episodes during 90 days of treatment, with about a 60% reduction persisting over the following six months.³³ A follow-up pilot study in children confirmed reduced infections, less antibiotic use, and fewer school absences.³⁴

These studies are small and mostly unblinded, so the results should be taken as promising rather than definitive. But the safety profile of K12 is excellent, and for someone facing the choice between repeated antibiotic courses and tonsillectomy, it may be worth discussing with a doctor as an intermediate step.

The Toothbrush Question

A surprisingly common piece of advice is to replace your toothbrush after recovering from a throat infection. There is a grain of truth here. Researchers found that group A strep bacteria persisted on non-rinsed toothbrushes for up to 15 days after pharyngitis treatment. However, toothbrushes that were rinsed under running water after use showed no surviving bacteria beyond day three.³⁵ So rinsing your toothbrush thoroughly after each use is likely sufficient, though replacing it after a strep infection is cheap insurance if you are prone to recurrences. A separate study found that broader hygienic measures like washing bed linens and replacing toothbrushes did not significantly change the recurrence rate of strep in families, suggesting that re-infection from household contacts is a bigger factor than environmental contamination.³⁶ If one family member has strep and others in the household develop symptoms, testing and treating the contacts is more productive than deep-cleaning every surface.