Shortening the Discomfort of Sore Throats

There has been a strong movement in the United States to limit resistance to antibiotics by insuring that we prescribe them appropriately for bacterial infections only and make sure we educate our patients to complete the course of the antibiotics to prevent the bacteria from surviving and developing resistance patterns. We have been taught that a “strep throat” is rarely seen in adults unless they are caring for children age 2-7 that are sick with a sore throat.

The patient should have a fever, swollen glands in the neck and an exudate on the tonsils or oropharynx. This constellation of findings and symptoms represents “Centors’ Triad” which conveys a high probability that a quick streptococcal assay or culture will be positive. For all other sore throats we are taught to treat it with lozenges, warm fluids and time. There is a definite and distinct effort to train doctors to not prescribe an antibiotic or a “Z Pack” for these non-beta hemolytic streptococcal sore throats.

It is with this background or preamble that I report on an article out of the October 17, 2018 International Journal of Clinical Practice that discusses the use of an experimental throat lozenge versus a placebo throat lozenge. The experimental troche contained a small dose of an antibiotic, tyrothricin plus benzalkonium chloride and benzocaine (an anesthetic). Tyrothricin is an antibiotic used overseas to treat gram positive organisms. It is incorporated into lozenges designed for children with non-streptococcal sore throats. This antibiotic has not demonstrated any issues with bacteria developing resistance yet.

In a clinical trial, patients 18 years of age and older with a painful sore throat which was not due to “strep” were randomly assigned to the study drug or placebo. The results were striking with more relief of pain at two hours in the study group than placebo, less difficulty swallowing and more resolution of symptoms at three days with the study drug than a placebo.

The medication used in the study is not currently available in the USA. If it is as successful as this study implies then when will it be introduced in the USA for symptomatic relief of those uncomfortable non-strep sore throats?

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