Written by Prof. Michael Borg, Head of Department of Infection Prevention & Control at Mater Dei Hospital in Malta & Chairperson for the National Antimicrobial Resistance Committee.
A sore throat is one of the most common winter illnesses, and it can make you feel awful—painful swallowing, scratchiness, swollen glands, fever and general discomfort. It’s very common to assume that antibiotics will help you recover faster. But in reality, for most adults, antibiotics make no difference at all.
That’s because the vast majority of sore throats are caused by viruses, not bacteria. Antibiotics only work against bacteria, which cannot do not work on viral infections.
Why antibiotics do not help viral sore throats
Antibiotics target bacteria, not viruses. When your sore throat is viral:
• Antibiotics cannot kill the virus
• They won’t shorten the illness
• They can cause unwanted side-effects
• Their overuse leads to antibiotic resistance, making future infections harder to treat
This is why healthcare professionals often repeat the message: “Antibiotics do not work on viral infections”.
That’s why healthcare professionals often repeat the message:
“Antibiotics don’t work on viral infections.”
Why this matters in Malta
Locally, sore throat remains one of the most common reasons for antibiotics to be prescribed in the community. Yet research shows that about 85–90% of sore throats in adults are viral. Only a small proportion are caused by bacteria such as streptococci.
When antibiotics are taken for viral infections, they:
- Don’t speed up recovery
- Don’t prevent complications like pneumonia
- Can cause side-effects such as diarrhoea, thrush and allergic reactions
- Contribute to antibiotic resistance, which makes any future bacterial infection you may get harder to treat
Using antibiotics only when they are truly needed helps protect your health, and helps keep antibiotics effective for yourself and those around you.
How can you tell if your sore throat is likely to be viral?
Most adult sore throats begin as part of a cold or flu-like illness. As a general rule, your sore throat is more likely to be viral if:
• You have a blocked or runny nose
• You are coughing
• Your voice is hoarse
• Others around you have similar symptoms
A simple tool called the Centor Score helps estimate whether a sore throat is bacterial. In particular, if you do NOT have:
• Fever of 38°C (100°F) or more
• Tender, swollen lymph nodes in the neck
AND
• Also have a cough and/or running nose
• Are 16 years or older
… your sore throat is almost certainly viral. Antibiotics will not help if all these four conditions apply.
Most adults with a sore throat score low on this scale, which is why the great majority of sore throats do not require antibiotics and get better with simple self-care.
How your pharmacist can help
In such situations, your pharmacist can often give you all the help you need. They can:
• Recommend suitable pain relief such as paracetamol or ibuprofen (if safe for you)
• Suggest throat lozenges, sprays or gargles that soothe pain
• Offer remedies for fever, congestion and inflammation
• Explain what symptoms are normal and when you might need medical review
These non-antibiotic treatments don’t kill the virus causing the sore throat, but they can make you feel much more comfortable while your body clears the infection on its own.
When should you seek medical advice?
You should speak to your GP or an urgent care service if:
- Your symptoms are very severe or getting worse
- You have trouble breathing, swallowing, or opening your mouth
- You develop a rash, or feel unusually unwell
- Your symptoms do not improve after 7 days
- You have a weakened immune system or a long-term condition such as diabetes, heart, lung or kidney disease
In these situations, further assessment is important. If your doctor suspects a bacterial infection, they may prescribe antibiotics.
What you can do if you have a sore throat
• Rest, drink plenty of fluids and take analgesic for pain relief
• Speak to your pharmacist for symptom relief options
• If you go to a doctor don’t put any pressure to prescribe antibiotics, as most sore throats are viral
• Seek medical advice if symptoms are severe, prolonged or worrying
The bottom line
- Most adult sore throats are caused by viruses and don’t need antibiotics.
- Your pharmacist can help with simple treatments that make you feel better.
- Antibiotics don’t work on viral infections and should be reserved for when they are truly required
By using antibiotics wisely, we help protect their effectiveness so they remain powerful, life-saving medicines for all of us — now and in the future.
For more information about antibiotics and antimicrobial resistance,
visit Antibiotics.gov.mt