Moderately dry air causes sore throats

What to do if you scratch, burn and have difficulty swallowing?

If you are only slightly ill, have mild to moderately severe swallowing difficulties, reddened throat and throat and / or a burning sensation in this area, sore throats can be treated as part of self-medication. In most cases a viral, less often a bacterial infection is the cause. The most common pathogens include rhino, corona and adenoviruses as well as β-hemolytic streptococci of groups A, C and G. If left untreated, the symptoms usually subside after three to five days, because in many cases the immune system makes the germs harmless.

But sore throats can be very uncomfortable and severely impair the quality of life. Therefore, those affected are grateful for the pharmacy's recommendation of a fast-acting, over-the-counter throat therapeutic agent. Such preparations can also provide a remedy for symptoms caused by irritation of the pharynx mucous membrane from dry air, dust or (passive) smoking.

Wide range of preparations

Sore throat relievers for local use are offered in the form of lozenges, gargle solutions or throat sprays. They contain disinfecting, antibiotic or local anesthetic agents, often in combinations (see Tab. 1). Products with plant extracts with anti-inflammatory, astringent, antiseptic or mucus-forming effects or teas or tea blends are also good recommendations (see Tab. 2). Gargling with warm sage or chamomile tea is particularly pleasant for those with a sore throat.


Tab. 1: Herbal throat therapeutics

tetesept® Neck-active lozenges
Kamillosan® Mouth and throat spray
* Numerous preparations contain combinations of active ingredients

Herbal medicinal products can be recommended if the effectiveness of the symptomatic measures is better documented and if the patient so desires, with restrictions. Herbal ingredients have an anti-inflammatory, mucus-forming, antiseptic, deodorant and astringent effect. Mixtures of traditional medicinal plants are also often offered. For most phytopharmaceuticals, however, there is no clinical proof of efficacy with controlled studies for sore throats.

If colds and sore throats are looming, preparations with dried pressed juice from Echinacea purpurea can also be used as monotherapy (e.g. Echinacin®) or in combination products (e.g. Esberitox®) are used. Homeopathics are also recommended for infections around the throat and pharynx (e.g. Meditonsin®).

The choice of preparations should be based on the preferences of the customer. A recommendation of lozenges or a throat spray is gladly accepted because of their ease of use. It should be noted that allergic reactions have been described as side effects for some synthetic active ingredients (e.g. hexetidine, benzocaine). Some sore throats because of their alcohol content are not recommended or only to a limited extent for alcoholic people, children, pregnant or breastfeeding women.


Tab. 2: Throat therapeutics with synthetic ingredients

Mallebrin® Concentrate for gargling
Mucoangin® for sore throat lozenges
Dobendan Strepsils® Dolo lozenges
Chlorhexamed® Fluid solution
Panthenol® 100 mg Jenapharm tablets
Locabiosol® S inhalation spray
GeloRevoice® Throat tablets
Wick® Sulagil throat spray, trachisan® Sore throat pills
Betaisodona® Oral antiseptic
Dorithricin® Throat tablets
* Numerous preparations contain combinations of active ingredients

Analgesics can only be used for a short time

Analgesics such as acetylsalicylic acid (also in combination with caffeine), paracetamol, ibuprofen or flurbiprofen (Dobendan Strepsils® directly lozenges) can effectively relieve sore throats. They are particularly recommended for pain relief until you are about to visit a doctor or at the start of antibiotic therapy. However, since they can mask the symptoms of a serious illness, they should only be used for a short time, i.e. for a maximum of three days.

Relief through home remedies

Even very simple measures - so-called home remedies - can help relieve a sore throat. These include above all:

  • drink enough
  • rest more often
  • Suck sweets (with menthol, sage or eucalyptus oil, e.g. Emser® Pastilles)
  • Gargle with salt water (a quarter of a teaspoon on a glass of water) or sage tea
  • Avoid (passive) smoking
  • If you have difficulty swallowing, prefer soft food, avoid spicy and spicy foods and alcohol
  • Keep warm and moist neck wraps or neck warm (e.g. with Medivital® Warming scarf)

Limits to Self-Medication

In the following cases, customers should be advised to see a doctor, as the symptoms can hide a serious illness:

  • with shortness of breath
  • for severe swallowing difficulties and pus-covered, swollen tonsils (tonsils)
  • if the symptoms have not improved after 3 to 5 days
  • with additional symptoms z. B. Rash, severely swollen lymph nodes, ear pain
  • if the temperature is> 39 ° C

Special attention is required in children and adolescents because diseases such as glandular fever (acute infectious mononucleosis) or scarlet fever can be the cause of sore throats. The symptoms of Pfeiffer's glandular fever caused by the Eppstein-Barr virus are similar to those of a cold in early childhood. Fever, swollen lymph nodes, pharyngitis, or rashes may occur in adolescents and adults. The virus, which belongs to the herpes virus family, infects B lymphocytes, which can easily be identified in the blood count as atypical cells (Pfeiffer cells). Scarlet fever, which is caused by β-hemolytic A-streptococci, also causes sore throats, fever, enlarged cervical lymph nodes and plaque in the mouth and throat. After just a few days, the typical small-spotted rash and the "raspberry tongue" indicate the disease. Children under two years of age should always see a doctor if they have a sore throat. This is also advisable for older patients, especially if there is uncertainty about previous or concomitant illnesses. Since people in old age mostly suffer from dry mucous membranes, it must also be taken into account that incorrect use of certain medicinal forms can cause irritation and pain in the throat area. For example, when alcoholic solutions are taken undiluted or tablets with too little liquid.

Guideline recommendations

Medical guidelines recommend reluctance to prescribe antibiotics for sore throats. The S3 guideline published in 2009 by the German Society for General Medicine and Family Medicine (DEGAM,) states, for example, that even positive streptococcal A detection is not an indication for routine antibiotic administration. The background for this is, among other things, findings from placebo-controlled studies in pharyngitis patients, in which antibiotics in most cases had a slight to moderately shortening effect on the duration of sore throats and other symptoms such as fever and headache. In the studies, the effect was most pronounced around the third day of treatment. But then around a third of those treated in the control groups were already free of pain and around 80% were free of fever, regardless of whether there was evidence of streptococci in the throat swab (see box: "Tips for patients"). If the doctor is considering antibiotic therapy, penicillin administration over seven days is the first choice.


TIPS FOR PATIENTS

Do you need an antibiotic?


In most cases, there is no need for an antibiotic for a sore throat. Antibiotics only fight bacteria, not viruses. However, sore throats are mainly caused by viruses. Bacteria, mostly streptococci, can be detected in some patients. However, germs can also be found in the throat of healthy people and many people also have streptococci in the throat without being sick. The body's immune system usually copes well with pathogens in the case of sore throat and tonsillitis, regardless of whether it is bacteria or viruses. Antibiotics may only be useful for more serious illnesses. The duration of the illness can be shortened by one to two days. However, whether the benefit is greater than the harm must be weighed up by the doctor on a case-by-case basis.

Lack of proof of effectiveness criticized

In various publications, the lack of proof of effectiveness for sore throat medicines is criticized. For example, the German Society for General Medicine and Family Medicine (DEGAM) found in its guideline "Sore Throat" published in 2009 that - with a few exceptions - there is no proof of benefit from randomized controlled studies for most synthetic and herbal active ingredients in throat therapeutics. The guideline therefore makes the statement: "The use of lozenges, gargle solutions and throat sprays is not recommended. ... The use of local antiseptics has been shown to make no sense, as they can only work on the surface, while the main infection takes place in the depths of the tissue The bactericidal / bacteriostatic effect of these substances, which has been partially proven in vitro and in vivo, is of no clinical relevance, even in view of the mostly viral throat infections. " Further information can be found at: www.awmf-leitlinien.de.


Ökotest: benefit not proven


The consumer magazine Ökotest has also dealt with sore throats and bought and examined 20 different ones, mainly lozenges and lozenges, but also spray and gargle solutions. All are approved as medicinal products, one of which is a traditional medicinal product. The conclusion of Ökotest: Regardless of whether the preparations have anti-inflammatory, germicidal or local anesthetic effects: their use for sore throats has no advantages. At best, they have a purely symptomatic effect without reducing the duration of the sore throat.

Short-term use of Trachisan only makes sense in the case of severe sore throats® Sore throat tablets with the locally anesthetic lidocaine. Reliable data from a study are available for this product, which is why Ökotest is the only one to rate it as "satisfactory", while all other products are rated as "poor" or "unsatisfactory".

[Source: Öko-Test December 2010.]

Source Lennecke, K. et al .: Self-medication. Guidelines for pharmaceutical advice, 3rd edition, Deutscher Apotheker Verlag, Stuttgart (2007). Sore throat. S3 guideline of the German Society for General Medicine and Family Medicine (DEGAM), as of October 2009, www.awmf-leitlinien.deRote Liste online, www.rote-liste.de

Pharmacist Dr. Claudia Bruhn