When Do You Need Antibiotics for a Sore Throat?
Key takeaways:
Viruses are the most common cause of sore throats. Antibiotics won’t help a sore throat caused by a virus.
You may need antibiotics to treat a sore throat that’s caused by a bacteria, like strep throat.
Many sore throats can be treated at home with over-the-counter (OTC) medications or home remedies. Signs you need medical attention for a sore throat include fever, trouble swallowing or speaking, and neck swelling.
Table of contents
One of the most common reasons people seek medical care is for a sore throat. In fact, sore throats account for 1% to 2% of all office visits each year. But most sore throats will go away on their own without antibiotics or prescription treatments.
So, how do you know if you really need medical care for a sore throat? Let’s look at the common causes of sore throats, when you can try to take care of it yourself, and when you should see a healthcare professional.
Quiz: Do I have strep throat?
What causes a sore throat?
The medical term for a sore throat is pharyngitis. Pharyngitis can be caused by germs like viruses and bacteria. Viruses — like the ones that cause the common cold — are the most common cause of sore throats.
Some of these viruses include:
Epstein-Barr virus
Rhinovirus
Parainfluenza
But many things other than bacteria and viruses can cause a sore throat. These include:
Acid reflux and gastroesophageal reflux disease (GERD)
Smoking
Dry air
Throat injury
Vocal strain from singing or yelling too much
Kids are prone to strep throat. Adults can get strep throat too, but it’s not common.
Not sure if you should get checked out? Our experts explain when to seek medical care for a sore throat.
Got diagnosed with strep throat? Here are nine strep throat remedies to try while you wait for your antibiotics to kick in.
Can you use antibiotics to treat a sore throat?
Sometimes you can use antibiotics to treat a sore throat. But they won’t help with most common causes of a sore throat like viruses, acid reflux, allergies, or vocal strain. Antibiotics are only helpful when your sore throat is caused by bacteria.
Group A Streptococcus is the main cause of strep throat. Strep throat is a bacterial throat infection that needs to be treated with antibiotics.
Other bacteria can also cause throat infections that need antibiotic treatment. These include:
Group C and G Streptococcus
Neisseria gonorrhoeae
Chlamydia trachomatis
Arcanobacterium haemolyticum
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Taking antibiotics for a sore throat not caused by bacteria won’t help you feel better faster. And taking unnecessary antibiotics puts you at risk for side effects (like diarrhea). It also contributes to antibiotic resistance.
How do you know if you need antibiotics for a sore throat?
The only way to diagnose a bacterial infection of the throat is with a throat swab. A healthcare professional will rub the back of your throat with a medical swab that looks like a long Q-tip.
Most primary care offices and urgent care centers can do a rapid strep test. This is a swab that will quickly determine if your sore throat is caused by group A Streptococcus bacteria.
But how can you tell if it’s worth going for a strep test in the first place? Your symptoms will give you important clues.
When sore throats are caused by viruses, people usually experience some or all of the following:
Coughing
Sneezing
Watery eyes
Runny nose
Hoarse voice
Oral ulcers
In contrast, signs and symptoms of strep throat include:
Sore throat that starts suddenly
Pain with swallowing
Fever
Tiny red spots on the back of your throat (also called petechiae)
White, patchy spots on your tonsils (also called exudates)
Tender lymph nodes in the front part of your neck
Do you need antibiotics for strep throat?
Yes. Group A Streptococcus is the bacteria that causes strep throat. While strep throat may go away without antibiotics, untreated strep can lead to complications. That’s why people with strep throat typically need antibiotics.
Strep throat is usually treated with penicillin or amoxicillin. People with a penicillin allergy may be treated with an alternative antibiotic like clindamycin or azithromycin. You can’t get amoxicillin, penicillin, or other antibiotics for strep throat over the counter. Antibiotics are prescription-only.
What are the benefits of taking antibiotics to treat strep throat?
A sore throat from strep throat will go away on its own, but antibiotics may help you feel better faster. They can shorten symptoms by about 16 hours.
Most importantly, antibiotics can prevent complications from strep throat. People with untreated strep throat can develop rheumatic fever, a serious complication that can lead to long-term heart disease. Antibiotics can also prevent complications like throat abscesses.
Another benefit to taking antibiotics for strep throat is that it stops you from being contagious. People who take antibiotics are no longer contagious within 12 to 24 hours of starting their antibiotic course. Without antibiotics, you can remain contagious for days to weeks and pass the bacteria onto others.
How long do antibiotics take to work for strep throat?
People usually feel better within 1 to 2 days of starting antibiotics for strep throat. Call your doctor’s office if you don’t feel like your symptoms are getting better within 48 hours of starting antibiotics.
Your primary care provider may need to check for other causes of your sore throat. It’s possible to have a viral infection at the same time as your strep infection. They’ll also make sure you haven’t developed a complication from strep throat like a throat abscess.
Group A Streptococcus isn’t resistant to penicillin. So, if you’re taking penicillin or amoxicillin for strep throat, it’s not likely that you’re experiencing antibiotic failure. But if you were prescribed a different antibiotic because of a penicillin allergy, there’s a small possibility that the antibiotics aren’t working against the bacteria.
What are some home remedies for sore throat?
There are many ways to treat a sore throat at home. If your sore throat is because of a viral infection, nothing can “cure” it — your body just needs time to clear the virus. While you’re waiting, it’s helpful to stay as comfortable as possible.
If you have a bacterial infection, like strep throat, these remedies can help relieve throat pain until your antibiotics kick in.
Over-the-counter pain medication
Over-the-counter (OTC) pain medications like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) will help relieve a sore throat. There’s some evidence that ibuprofen works better than acetaminophen for throat pain. These medications usually start working within 1 to 2 hours, and the effects last for 4 to 6 hours.
You can start with lower doses of acetaminophen or ibuprofen and still get great pain relief.
Lozenges and sprays
Various lozenges (drops) and sprays are available OTC to help with sore throat. Lozenges and sprays act faster than acetaminophen or ibuprofen, but their pain relief doesn’t last as long. It’s best to use a lozenge or spray with an OTC pain reliever. Currently, there’s no evidence that one type of spray or lozenge works better than another.
Most people choose based on personal preference, taste, and availability. It’s important to remember, lozenges are a choking hazard and shouldn’t be given to young children. Use sprays instead.
Cold fluids
There’s some evidence that cold fluids can relieve a sore throat by temporarily numbing the nerves in the back of your throat. While the effects won’t last too long, they may help keep you comfortable until the OTC pain medication kicks in. Very cold fluids or foods work best — think frozen and not refrigerated items. Popsicles and ice chips are great options.
Warm fluids
Warm fluids — like tea, broth, or soup — can also help temporarily relieve your sore throat. Make sure liquids aren’t too hot. Hot liquids can scald the back of your throat, making the pain worse.
Saltwater gargles
Gargling with salt water can also help relieve a sore throat:
Mix ¼ to ½ tsp of regular table salt in 8 oz of water
Gargle for 10-20 seconds, as tolerated
Children who are too young to understand how to gargle shouldn’t use this remedy.
Salt water gargles won’t kill the germs causing your sore throat — whether from a virus or bacteria, including COVID.
When should you see your doctor about a sore throat?
If you have symptoms consistent with strep throat, or if you’re at higher risk of strep throat because of your age or job, see a healthcare professional for a strep test.
Children, especially those between 5 and 15 years old, are more likely than adults to get strep throat. But adults can get strep throat too, especially if they spend a lot of time around children.
In general, you should see a healthcare professional if:
You have a fever.
You think you could have COVID. Sore throat is a common symptom of COVID illness.
Your sore throat is getting worse. A sore throat from a virus should go away within a few days. And it shouldn’t get worse over time. If your sore throat isn’t getting better after 2-3 days, even if home remedies are giving you temporary relief — you should see a healthcare professional. You could have a sore throat for a different reason.
You have severe symptoms like neck swelling, trouble swallowing, voice changes, difficulty speaking, or pain that makes it hard to move your neck.
Frequently asked questions
No. Antibiotics are available by prescription only, so you’ll need to see a healthcare professional and be tested for a bacterial infection before taking an antibiotic for strep throat.
No. Unfortunately, there’s no cure for the common cold. Colds are caused by viruses, and antibiotics don’t work on viruses.
The bottom line
Many things can cause a sore throat, but viruses are the most common cause. Only sore throats caused by bacteria need antibiotic treatment. People with fever and sore throat are more likely to need antibiotics. Some helpful remedies for sore throat include OTC pain medications, cold and warm fluids, and throat sprays or lozenges.
Why trust our experts?
References
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Centers for Disease Control and Prevention. (2024). Clinical guidance for Group A streptococcal pharyngitis.
Harberger, S., et al. (2024). Bacterial pharyngitis. StatPearls.
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McCraig, L. F., et al. (2002). Trends in antimicrobial prescribing rates for children and adolescents. JAMA.
National Health Service. (2024). Sore throat.
Sauve, L., et al. (2021). Group A streptococcal (GAS) pharyngitis: A practical guide to diagnosis and treatment. Paediatrics and Child Health.
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