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Everyday symptoms

Sore throat – when it needs antibiotics, and when it does not

Most sore throats are viral and settle on their own. The minority that are bacterial matter, because untreated strep can damage the heart.

Why this one matters more in South Africa

Most sore throats are caused by viruses and need nothing but time. A minority are caused by a bacterium — group A streptococcus — and that minority matters here more than in many countries, because untreated strep throat can lead to rheumatic fever and permanent heart valve damage.

Rheumatic heart disease remains a significant problem in South Africa, and it is entirely preventable by treating the throat infection that precedes it. This is why a sore throat in a child or young person is taken more seriously here than the symptom alone might suggest.

What points towards bacterial

  • Sudden onset with fever, and no cough — a cough points towards a virus.
  • White patches or pus on the tonsils.
  • Tender, swollen glands in the neck.
  • Pain on swallowing severe enough to affect eating and drinking.
  • Age between about 3 and 15, where strep is most common.

None of these is proof — the signs overlap heavily with viral illness, which is exactly why a clinician assesses rather than guessing from a list. A clinic can examine the throat and decide.

Relieving it

  • Salt water gargles, several times a day.
  • Cold drinks, ice lollies or warm honey and lemon — whichever suits.
  • Paracetamol or an anti-inflammatory, which also reduces the swelling.
  • Medicated lozenges or a numbing throat spray for short-term relief.
  • Keep drinking. Dehydration from avoiding swallowing makes everything worse.

Commonly used:

  • Paracetamol — Panado, Painamol, Tylenol, Pacimol

    Mild to moderate pain; fever

  • Ibuprofen — Nurofen, Brufen, Advil, Ibupain

    Mild to moderate pain; inflammation; fever; dysmenorrhoea

  • Benzocaine + Cetylpyridinium / Throat Lozenges — Cepacol, Strepsils, Andolex Lozenges, Halls Medicated

    Sore throat; pharyngitis; tonsillitis symptom relief; mouth ulcers

  • Benzydamine + Chlorhexidine (Oral Rinse/Spray) — Andolex-C, Andolex-C Oral Rinse, Andolex-C Spray, Difflam

    Severe sore throat; pharyngitis; post-tonsillectomy pain; mouth ulcers; gingivitis

Signs that need urgent care

Also go back if the throat has not improved in a week, if there is a fever that will not settle, or if you develop joint pains or a rash in the weeks after a throat infection — those can be early signs of rheumatic fever.

Common questions

Can I ask a pharmacist for antibiotics for a sore throat?
Antibiotics need a prescription in South Africa. A pharmacist can help with relief and will tell you when the picture needs a doctor — which is the right use of the visit.
Are tonsils worth removing if I get sore throats often?
Sometimes, but the threshold is high — several well-documented episodes a year over more than one year. It is a decision for an ear, nose and throat specialist rather than a response to a bad winter.
How long is strep throat contagious?
Generally until about 24 hours after starting an appropriate antibiotic. Untreated, it can be passed on for two to three weeks, which is another reason treatment matters.

Sources

Last reviewed 4 August 2026.