11 best antibiotics for sore throat

*Review of the best according to the editorial board. About the selection criteria. This material is subjective, not intended as an advertisement, and does not serve as a guide to purchase. Before buying it you should consult with a specialist.

We all know sore throat from childhood: as an adult we rarely get it, but if we get it, it usually becomes much worse than in children. After all, in order for an adult to get a sore throat, there must be some defect in immunity, local or general. Currently, public opinion is largely distracted by coronavirus infection, and for obvious reasons, acute respiratory viral infections, influenza and angina are undeservedly pushed aside. But this does not mean that angina has ceased to occur in patients of all ages, and it is necessary to recall the danger of this disease. Angina needs to be treated properly, and almost always, locally or as a systemic treatment (injections, pills) with angina need antibiotics. About this type of treatment and the story will go, but first let’s talk about the disease itself.

Angina, or acute tonsillitis, is a seasonal disease that occurs most often in winter and autumn, and can be associated with an unfavorable epidsituation. Yes indeed, sore throat is a bacterial infection, and the epidemic is caused by SARS and influenza. How to Combine This? Very simple: viral agents weaken the body, and after the primary viral attack in the form of a respiratory infection, sore throat joins as a secondary, bacterial complication. This is what allows angina to “live” by the laws of epidemics.

The general susceptibility of the population to sore throats of various etiologies is usually up to 20%. This means that out of 10 people in the occurrence of situations favorable for the disease will fall ill two. That’s not much: by comparison, a primary pneumonic plague will make 99 out of 100 people sick, and 98 will die without treatment. Sore throat has a variety of symptoms. But before describing the symptoms and treatment, it should be explained at once under what conditions it is necessary to call an ambulance. What conditions in angina are life-threatening?

Urgent conditions of sore throat

Sore throat itself, with sore throat, high fever, plaque on the tonsils, of course, unpleasant, but there is nothing dangerous and life-threatening in this condition. What are the warning signs of complications of angina? At least not a high fever, or fever. The fever can be brought down and the patient feels better. The ambulance should be called if the patient has the following signs:

Dyspnea grows.

Respiratory rate rises above 20 per minute, and increases steadily. Signs of an insufficient supply of blood with oxygen: this is the so-called cyanosis, which is manifested by turning blue of the nail bed, the nasolabial triangle, and the lips. Dyspnea indicates that due to intense intoxication, there is swelling of the larynx. The narrowing of the hole for conducting air into the lungs leads to the fact that the body can not be properly supplied with oxygen, and this condition is fraught with elementary suffocation. The issue can be resolved very quickly. The doctor intubates the patient and inserts an endotracheal tube, or, as a last resort, may make a hole below the level of swelling so that the patient can breathe freely. This emergency surgery is called a tracheotomy, and it saves a person’s life;

Sudden increase over several hours of puffiness of the face, neck, inability to turn the tongue in the mouth, without or in the background of choking.

There is swelling of the soft tissues in the oral cavity that can go down into the neck. This be characteristic of severe, toxic forms of angina, or even talk about the occurrence of phlegmon of the floor of the mouth, or Ludwig’s angina. Swelling is even indicative of a severe course of diphtheria, which was initially mistaken for angina. Such diffuse widespread edema must be treated urgently, with an accurate diagnosis beforehand. If it is a phlegmon, then urgent surgical treatment is necessary, and if it is diphtheria, then hospitalization in an infectious hospital with a massive injection of serum and specific treatment is necessary;

A sardonic smile, difficulty or inability to open the mouth.

This condition sometimes develops with angina, but not due to edema, but due to muscle spasm or spasmodic contraction, the so-called trismus of the jaw muscles. The classic condition of trismus is the debut of tetanus, but in angina this process is reflexive, due to irritation of the muscles with purulent abscesses, or have a toxic nature. If when the patient has difficulty opening the mouth when examining the pharynx there is a clear asymmetry, with a clear shift to the center of the swelling on one side, we are most likely talking about the formation of an abscess, and this requires urgent surgical treatment;

In severe sore throat, the patient may have excessive salivation and salivation, find it very difficult, or impossible, to swallow due to the painful.

All this is a reason to call an ambulance urgently. As you can see, this group has only local symptoms of the condition of the oropharynx and surrounding tissues. Yes, the patient may have a general pronounced intoxication, but it is hardly necessary to call an ambulance even against a background of high fever. What the doctor, or paramedic ambulance will do in this case? He will put a lytic mixture, a “triplet,” that is, analginum, dimedrol, and nostropa. Cheap and sultry. The temperature should be reduced if it rises above 39 degrees, but in the normal course of angina there is no need to call an ambulance.

When you can’t be treated at home?

And when, in general, the patient in the presence of acute tonsillitis, or sore throat, it is desirable to hospitalize, and not to treat at home? Almost all of us had sore throat in childhood at home, and in the hospital those patients were admitted who had any risk factors that could give sore throat a severe course. What are these conditions?? First of all, it is:

  1. Young children, younger than 2 years old with a verified or presumptive diagnosis;

  2. Patients with severe chronic pathology, such as cardiovascular failure, heart defects, epilepsy and diabetes mellitus;

  3. Patients with secondary or primary immunodeficiency, with HIV infection;

  4. Elderly patients who endure angina severely, against the background of high fever and vivid development of the clinic;

  5. Hospitalization may be for epidemiologic reasons, when the patient must be removed from the community. This applies to orphanages, nursing homes, sanatoriums and other places of organized permanent residence.

However, practice shows that the majority of sore throat cases are treated at home. Back to acute tonsillitis. Let’s tell briefly what a sore throat can be, and how it runs in its classic form.

Angina and its types

The term “sore throat” itself means either “choke” or “squeeze”. This is a figurative definition, but such a statement is true for the severe form, when the swelling of the tonsils goes down, the larynx swells and there is actual, life-threatening choking. But, more often than not, fortunately, such difficulty in breathing does not occur. The tonsils may be inflamed on both sides, may be sharply swollen, and cause some discomfort.

Modern medicine believes that sore throat is a complex, not only infectious, but also allergic process that affects the glands of the so-called Pirogov-Waldeyer ring, or the main tonsils of the pharyngeal lymphoepithelial protective ring. The main objects of inflammation in sore throat will be the palatine tonsils. Sore throat can be a unilateral or bilateral process, which is much more common. Asymmetric sore throat is always suspicious. Chronic tonsillitis also occurs, which in Soviet times was diagnosed as a diagnosis for every tenth child.

Angina can be different, such as catarrhal, purulent, necrotic, or even ulcerative. What are the symptoms and signs that tell us about the occurrence of acute tonsillitis, or angina?

Symptoms and Signs of Angina

Like any infectious disease, sore throat has an incubation period, but it is short, and usually does not exceed 4-6 days, maximum – weeks. Classical sore throat has an acute onset: there is pain in the throat, painful swallowing, followed by general signs of intoxication. Any sore throat causes lymphadenitis, or regional lymph node reaction, in addition to oropharyngeal damage and intoxication. Let us elaborate on these three important diagnostic signs:

The involvement of the tonsils always begins with bright hyperemia, or bright redness.

The reddening of the tonsils is usually limited to the sinuses, And in the beginning there are no signs of suppuration, that is, there is a catarrhal, “clean” process. Sometimes there is a pitting rash on the tonsils, or on the soft palate, but not purulent, but, for example, of hemorrhagic nature. In some cases, the process stops at the stage of this catarrhal inflammation, and no pus occurs. In this case, the sore throat is mild, the person quickly recovers.

If at this stage effective treatment is begun, and not only with antibiotics, but also with local preparations, rinses, irrigation of the pharynx, with antiseptics, then such even severe, purulent angina can be “curbed” in time and stop its development at this stage. But, unfortunately, at the stage of catarrhal sore throat, few people take a full set of measures, and pus masses still appear on the tonsils.

It can be punctiform suppuration, in the form of follicles, and such a sore will be called a follicular sore. Pus fills the lacunae of the tonsils in peculiar islands or lakes. In such a case, there will be whole purulent large spots on the tonsils, which may merge. Finally, there is also a necrotic process, when painful ulcers form on the tonsils, making it extremely difficult to swallow;

Regional lymph nodes are involved in the inflammatory process.

Most commonly, these are submandibular and cervical nodes. In fact, the lymph nodes are not inflamed at all, they just start working with an increased load, because they take part in local immunity reactions, ensuring the fight against the pathogen. A really inflamed lymph node, for example, in syphilis, at the stage of primary syphilis. It is enlarged, it is red, it is painful. In sore throat, the lymph nodes are not red, they are painful only with intense palpation, but they themselves do not differ from body temperature to the touch, and are mobile, the skin above them is unchanged. As a rule, lymphadenitis occurs a day or two after the first symptoms of sore throat and redness of the tonsils, or develops together with them.

Finally, the general intoxication syndrome is a universal systemic reaction of the body.

In severe sore throat, fever may be preceded by violent chills and then by a sharp rise to 39 degrees or higher. Babies may experience nausea and vomiting, and febrile convulsions may occur in conjunction with a high fever. In such a case, the baby must be hospitalized, this is another reason for treating young children in hospitals.

The patient has an understandable feeling of brokenness and weakness, there is a headache, severe sore throat runs with aching joints, lower back, with a lack of appetite and other understandable symptoms that are caused by bacterial toxins and the body’s fight against the pathogen.

What are the different types of sore throat?? What is clear to a person without medical education? It turns out that a lot.

Catarrhal sore throat

Basically, we described catarrhal angina above. This is a sore throat, in which there is no pus on the tonsils, on the sinuses, when there is pure catarrhal inflammation. Yes, there is hyperemia and swelling, there are symptoms of general intoxication, but they are expressed moderately. The disease is quite tolerable. There is pain in the throat when swallowing, there is a fever, it may be subfebrile or even normal. Mild general malaise bothers the patient, but usually only mild. This catarrhal sore throat is always at the beginning, and if it is not treated, the next day there can also be different types of suppuration on the tonsils. Catarrhal sore throat needs the most careful approach. Do not bear it on your feet under any circumstances, because it can become chronic, and streptococcal infection, turning into a chronic form, can respond with chronic damage of the heart and joints, rheumatic pathology in many years.

Follicular form

A catarrhal sore throat is different from a catarrhal one, because small whitish-yellow pus spots, or purulent follicles, are already visible on the tonsils. These follicles are located against a bright background of swelling and redness, like specks on the cap of a red fly agar. The sore throat is much worse, and the pain is sharp when swallowing. Sometimes, patients complain that the pain on swallowing from the throat travels to the ear, and this is associated with swelling of the auditory tube. General symptoms of intoxication are more pronounced than in catarrhal angina. The temperature clearly rises to febrile digits, weakness will be a concern, with a rise in temperature sometimes chills are possible, or even joint and lower back aches. With this form of sore throat it is necessary to prescribe antibiotics, and not only locally, as part of lozenges and lollipops, as well as sprays to irrigate the tonsils, but also as systemic therapy, that is, tablets or injections.

Lacunar sore throat

Lacunar sore throat is the next stage in the increase in the number of suppuration on the tonsils, and it runs more severely. Pustules are no longer visible as follicular dots, but as entire islands and glades, like a geographic map. No individual pus points are visible, and the plaque is a spilled field, with minor lumen of bright red tonsils, free of pus. The regional lymph nodes are quite painful, and the pain occurs even when turning the head. In severe cases, the patient will have difficulty opening the mouth, excess salivation occurs, and pain radiates to the head and ear when trying to swallow.

Taking solid food is difficult because of the sharp soreness; the patient prefers to drink liquid soups, broths, or compotes in small sips. Due to the fact that small sips have to be made frequently, the patient is in great pain, and before eating, help in the form of irrigation of the tonsils with Lidocaine spray is possible. Yes, they will lose sensitivity and become numb, just like the cheek mucosa goes numb in the dentist’s office, but this allows the patient to eat more or less comfortably. In addition to lacunar angina, there may be other types, such as ulcerous-flamous, or toxic, necrotic angina, but they are quite rare, and we will not spend unnecessary time describing them.

Caution: complications of sore throat!

Any sore throat, at any age, especially in children and the elderly, should be treated with extreme caution. If acute tonsillitis is not treated, it will develop into a chronic form, and causes chronic rheumatic damage to the joints, heart valves and myocardium. But even before such distant complications, quick, urgent conditions can also happen.

These include several types of abscesses, where pus from the tonsils erupts into the tissues, these are peritonsillar and retropharyngeal, or glossopharyngeal abscesses. If pus begins to accumulate under the mucous membrane of the oral cavity near the tonsil, there will be a sharp deterioration of health, a strong fever, chills, and the tonsil on the side of the abscess will bulge asymmetrically to the center, displacing behind it with the entire complex of oropharynx structures, including the uvula. Such a patient needs urgent surgical intervention: puncture of the abscess wall, release of pus, followed by irrigation and drainage. This is also the way a pharyngeal abscess is treated, when pus accumulates behind the tonsils, or even near the back of the pharynx.

Of the distant complications we may note inflammation of the joints, myocardium and heart valves, rheumatic polyarthritis, which we have already mentioned, and kidney damage, or glomerulonephritis. It occurs in classical, streptococcal sore throat. In angina glomerulonephritis, the filtering mechanism, or the renal glomeruli themselves and their apparatus are affected. Nowadays, with modern and timely recognition and treatment of angina, glomerulonephritis occurs in 1% of cases of primary angina, and in 3-5% of cases of recurrent forms and chronic tonsillitis, which is not a small number.

The cause of such glomerulonephritis is autoantibodies, which, instead of fighting the streptococci, start attacking the kidney’s own tissues. Usually such glomerulonephritis occurs after the temperature has normalized: this is the second week of the course of the disease, or even earlier: day 7-9.

The patient at this time considers himself almost healthy, but at this time he has immune inflammation in his kidneys, and without symptoms. Glomerulonephritis can be detected by laboratory urinalysis. Proteinuria, i.e. increased protein in the urine, increased number of erythrocytes and leukocytes, cylinduria will indicate inflammation.

If the patient has frequent sore throats, the resulting glomerulonephritis significantly reduces the ability of the kidneys to function fully, which will eventually lead to kidney failure. Lesion of the heart muscle, or myocarditis, occurs much earlier, and even appears against the background of the development of the acute picture, at the beginning of the disease. This kind of myocarditis also manifests itself extremely covertly, with only an increase in LDH enzyme in the blood and changes on the ECG. No pain in the heart, no shortness of breath, no decrease in tolerance to cardiac load myocarditis will not manifest itself, this is its insidiousness. That is why patients need to record ECG several times during the hospital treatment of angina, and if he is treated at home – do not be lazy, and after recovery be examined by a cardiologist.

There may be other, rarer complications. We have already said about toxic swelling of the larynx, about choking, but we must not forget that there are also tonsillogenic sepsis, meningitis, osteomyelitis, and the occurrence of distant purulent foci that have been spread through the blood, that is, hematogenous dissemination. That is why it is necessary to treat even a catarrhal, simple sore throat thoroughly, correctly, and with all perseverance.

Watch out for streptococcus!

We have taken a very detailed look at angina “from all sides”, but we have not yet said a word about the main culprits that cause angina, and the complications associated with them. The most important microorganism that still causes different types of sore throats is the famous group A beta(Y1E9E↩)-haemolytic streptococcus, which is also “guilty” of rheumatism. Its type is called Streptococcus pyogenes, pyogenes, i.e. pus. It quite often causes various inflammatory diseases of the throat in children and adolescents, and the frequency of its detection ranges from 25 to 58%. Somewhat less frequently, angina can be caused by a viral infection, streptococci of other groups, gonorrhea pathogens (!), in severe cases – diphtheria bacillus, various anaerobes and spirochaetes. This type of angina includes Simanowsky-Plaut-Vensen’s angina.

In the past, sore throats caused by mycoplasmas and chlamydia, i.e. intracellular parasites, were very rarely diagnosed. But now, with the widespread spread of HIV infection and the emergence of a large number of immunodeficiency cases in persons with undiagnosed HIV lesions, these sore throats have become much more common.

Acute tonsillitis, which is caused by beta-haemolytic streptococcus and can lead to acute rheumatic fever, is most likely in the Russian Federation in early spring. Various influenza pharyngitis, pharyngitis with coronavirus infection, which runs in the form of mild acute respiratory infections, respiratory syncytial viral angina most often occur either in the fall or winter.

However, do not think that the worst in this series will be coronavirus tonsillitis. After all, humanity is frightened of a pandemic, although it is not as severe as an infection caused by group A beta-haemolytic streptococcus.

At the very end of the twentieth century, in some countries of the European Union, and in the United States were recorded extremely severe cases of infection caused by this streptococcus, which, in addition to local signs of angina, complicated by severe general symptoms: this decrease in blood pressure, the development of DIC, or, as they called earlier, coagulopathy consumption, symptoms of multiple organ failure. In fact, these were special cases of infectious-toxic shock caused by an aggressive streptococcus.

In a number of cases, it was possible to determine the cause: it was soft tissue and skin infections, various streptoderms. But in 15% of the cases, there were no purulent infections of the soft tissues and skin, and the entry gates were primary bacterial foci localized on the tonsils and other lymphoid structures located in the oropharynx.

Additional U.S. studies ending in 1992 showed almost identical incidence curves of cases of this toxic shock caused by hemolytic streptococcus and angina. This particular “virulence” of beta-haemolytic streptococcus can lead to ineffective treatment of angina. Of course, this is a purely medical question. But after all, if we undertake to list the antibiotics that should help, we must also be alert to the possibility of ineffective treatment, which sometimes even experienced physicians. So why can the results of antibiotic prescriptions for angina be ineffective?

Why Antibiotics Didn’t Work?

First of all, let’s define when a doctor can “suspect something is wrong” and realizes that an antibiotic is not working as it should. Above all, these are:

  1. Within 3 days after the start of antibiotic treatment, symptoms persist, there is no improvement, or, on the contrary, the condition of the patient, most often a child, worsens;

  2. After completing a normal course of antibiotic treatment with proven improvement, beta-hemolytic streptococcus group A is still isolated from the oropharynx and nasopharynx, and the patient passes to the group of carriers, very alarming by the possible recurrence and transfer of angina into a rheumatic and autoimmune process.

Studies have been conducted, which at the beginning of the 21st century revealed that such ineffectiveness is most often seen in cases of treatment with phenoxymethylpenicillin (Osen). In some cases, the pathogens were in the oropharynx in microbial associations in which beta-lactamase was produced, and then unprotected penicillins also had insufficient efficacy. In such cases, it was necessary, after conducting bacteriological examination of smears and determining the sensitivity of the pathogen to antibiotics, to treat with a “dual” or protected antibiotic, according to the principles of a rational approach. Of course, this is amoxicillin plus clavulanate, for example, the same Amoxiclav or Augmentin.

Studies conducted in different countries have shown that if a patient prior to antibiotic treatment has isolated group A beta-haemolytic streptococcus and penicillin therapy was administered, then the failure of treatment could be as high as 38% of all cases. Additional causes of this “medication fiasco” have been identified. After numerous studies, it turned out that the failure of treatment leads to:

Quite low adherence of patients, especially children.If antibiotics help, then on the fourth day after admission the fever disappears, sore throat decreases, and in 6 days there are almost no symptoms of angina caused by streptococcus. Therefore, many parents believe that there is no longer a need to “feed” children with antibiotics further. This is a gross mistake, the result of the lack of understanding between the parents and the doctor, who simply did not explain the purpose of the treatment, and the reason for taking antibiotics for a few more days after the normalization of the condition.

Studies have been conducted that have shown that if antibiotic must be taken for 10 days, then on the ninth day continue to be disciplined to follow the doctor’s orders, and take antibiotic no more than 10% of all patients, and the rest arbitrarily quit treatment. Such too short courses contribute to the development of drug resistance in almost all pathogens;

There are reasons when patients are not to blame.For example, if penicillins are given, they can be destroyed by germ beta-lactamases, which is not uncommon. Especially if the patient is in kindergarten, school, day care center, that is, in a closed, or semi-closed community. There is a risk of “recurrent” streptococcus, i.e. reinfection.

The cause of reinfection may be the patient himself, who, having been treated, infects himself. For example, a child’s toothbrush, which the child used during the height of the symptoms of angina and then, contaminated with pathogens, continued to use after clinical improvement. In a day or two, after the start of antibiotic treatment, such a brush should be parted with and a new one should be bought. Similarly, removable orthodontic appliances and dentures can be sources of infection;

Disturbance of biogeocenosis in the oropharynx.Normally we are protected from beta-haemolytic streptococcus by our normal saprophytic microbes. If the microbial community has been weakened, destroyed by antibiotics, (the normal flora, above all, includes alpha-hemolytic streptococcus). Here such antibiotic can “help” the causative agent of angina and disrupt microbial protection;

Finally, the reason for such unsuccessful treatment may be the pre-existing long asymptomatic carrier of beta-hemolytic streptococcus.

It was shown that even among healthy children, the incidence of such a carrier was about 3%, and the children were clinically completely healthy and were pure “carriers”.

Those who are interested in this problem, Please refer toTulupov D.a. And Karpova E.p.: “Antibacterial therapy of acute and chronic recurrent tonsillitis in children”, Russian Medical Academy of Postgraduate Education, Department of Pediatric Otorhinolaryngology, Journal of Effective Pharmacotherapy. Pediatrics #2.

Most common errors

Now that we know about the causes of microbial resistance, we should name the mistakes that are most often made when prescribing antibiotics for acute tonsillitis:

  1. Doctors may neglect bacteriological testing, or microbiological testing, above all. This would only be an empirical, blind treatment. It leads to the fact that with the disappearance of symptoms and normalization of the temperature, the treatment is considered complete, while the patient may form a chronic carrier of beta-hemolytic streptococcus;

  2. the doctor may emphasize local treatment, the prescription of antiseptics, various gargles, but at the same time take care of the adult’s body, or, yielding to the pleas of too active parents “not to give antibiotics”. Such false “care” is costly, because for proper treatment it is necessary to create a concentration of the active substance not only outside, but also in the blood, from the inside. It is known that the surface of tonsils is riddled with deep crypts, and inside these crypts the pathogens can reliably “hide” from rinsing and the action of local antiseptics;

  3. the doctor may prescribe not what he or she treats, but those drugs that the poor can afford. As a result, instead of normal therapy the patient receives ineffective co-trimoxazole, tetracyclines, sulfonamides, and other drugs, which successfully treated angina, but long ago, in the sixties and seventies of the XX century;

  4. one of the biggest mistakes mentioned above is unnecessarily ending antibiotic therapy early, as soon as there is improvement. Adult patients, and even more so, parents of sick children, should be informed about the harmfulness of such rejection;

  5. Do not assume that beta-hemolytic streptococcus remains stable, and does not arm itself against new antibiotics. In the late 20th century, resistant strains of beta-haemolytic streptococcus emerged in Japan and Europe to macrolides, and other antibiotics, and only prescription control helped to deal with the rise in resistance.

Interested in the problem of the prevalence of angina caused by group A beta hemolytic streptococcus and peculiarities of its treatment, I refer you to the following text: B. s. Belov, Research Institute of Clinical Rheumatology, Moscow.

Modern antibiotics for sore throat

Those who have read the material carefully have understood that the treatment of any sore throat is a serious matter. For catarrhal forms, antibiotics are also needed, but you can get by with local application. As soon as we talk about suppuration, follicular, and even more so, the lacunar form of angina – then antibiotics should be used both topically and in the form of systemic therapy, that is, in the form of tablets or intramuscular injections.

If the antibiotic is bacteriostatic, it firstly leads to the cessation of the multiplication of the pathogenic flora on the tonsils. If the antibiotic is bactericidal, the pathogenic flora is killed and this reduces the local pain and inflammatory syndrome on the tonsils and in the oropharynx. Rational (i.e., with a known causative agent), or even empirical (with an unknown), but correct use of antibiotics for sore throat prevents the development of complications. Concomitant treatment with nonsteroidal anti-inflammatory drugs relieves fever. A fluid load and vitamin drinking regimen helps to quickly eliminate general intoxication. We will not discuss the individual stages of non-drug and local treatment of angina, for those who are interested we refer to the corresponding article: “How to treat angina correctly”.

Below we will look at which antibiotics for the treatment of sore throat are currently the most relevant and prescribed. But before we proceed to describe them, it is necessary to remind that all antibiotics are now prescription, they are prescribed only by the doctor, and as self-medication they should not be used under any circumstances. This material on antibiotics is for information purposes only, and is not an invitation to purchase any medicine. All indications in this list correspond to national and clinical guidelines, as well as to national and international protocols for the management of patients with acute tonsillitis under antibiotic therapy.

For each antibiotic, the international nonproprietary name, or INN, is given first. Here are some names of quality drugs and their price. The price is valid for pharmacies of all forms of ownership in the Russian Federation until January 2021.

Overview of the best antibiotics for sore throat

Modern antibiotics for angina1Azithromycin (Sumamed)99 €
2Amoxicillin(Flemoxin Solutab)194 €
3Cefexim (Suprax, Ceforal, Panzef)437 €
4Spiramycin (Rovamycin)1 122 €
5Amoxicillin+clavulanic acid (Augmentin, Amoxiclav, Arlette)100 €
6Benzylpenicillin14 €
7Clacid (Clarithromycin)522 €
8Cefotaxime (Claforan)38 €
9Josamycin (Wilprafen solutab)513 €
10Midekamycin (Macropen)407 €
11Roxytromycin (Rulid, Esparoxy)279 €

Azithromycin (Sumamed)

Rating: 4.9

Azithromycin (Sumamed)

Azithromycin, or Sumamed, is a first-line drug in the treatment of various sore throats. This medicine is not cheap. Three Sumamed tablets weighing 500mg each can cost more than 500 rubles. Sumamed is currently manufactured by Pliva of Croatia. Sumamed contains azithromycin, a bacteriostatic broad-spectrum antibiotic from the macrolide group, and macrolides should be preferred to treat various forms of angina, as they successfully fight pneumonic streptococci.

The drug affects microorganisms by inhibiting the synthesis of the protein of microbial cells. In high concentrations, it is bactericidal, active against a number of both Gram-positive and Gram-negative, anaerobic and even intracellular microorganisms. Sumamed is indicated for catarrhal, and purulent forms of angina. And it must be given as a single tablet once a day, for 3 days. Accordingly, the course dose is one and a half milligrams, or one pack.

Advantages and disadvantages

A big plus of Sumamed is considered high activity, as well as perfect compliance. Only one tablet a day is needed. Sumamed is taken in a short course, for 6 days maximum. Sumamed also shows activity against anaerobes, which can also cause some types of angina, both in pure form and as part of the mixed flora. In addition to the usual, streptococcal sore throat, chlamydial sore throat, or even caused by other intracellular parasites – mycoplasmas – occurs in conditions of reduced immunity. Sumamed is good for these diseases as well.

Sumamed rarely causes any side effects, such as malaise or allergic reactions. A minus of Sumamed can be considered a relatively high price, above 500 rubles for only three pills. But it should be borne in mind that two such packages, or 1000 rubles is a full course.

If we are talking about sexually transmitted infections, then the course of intake is only one tablet! Sumamed is currently a universal drug, and it cannot be discounted that it helps prevent secondary bacterial pneumonia after a coronavirus infection.

Amoxicillin (Flemoxin Solutab)

Rating: 4.9

Flemoxin Solutab

These are soluble tablets of synthetic aminopenicillin, their representatives would be Amoxicillin. Flemoxin Solutab are dispersible tablets, in dosages of 125 mg, 250mg, 500mg, and even 1g. This medicine for angina is a powerful antibiotic of bacteriostatic action, it is good to use against streptococci and staphylococci, and it is representatives of these microorganisms that most often cause angina. In uncomplicated sore throat in adults, Flemoxin should be used at 250 mg once or twice a day, with follicular or lacunar sore throat the dose should be doubled, at 500 mg twice a day. A course of 1 or 2 weeks, the doctor decides. Produces Flemoxin Solutab Dutch company Astellas Pharma, and it costs inexpensive for European quality: a package of 20 soluble tablets containing 500 mg of the drug can be purchased at a price of 300 to 350 rubles.

Advantages and disadvantages

The tablets dissolve well and quickly, they smell like fruit, although it has not been possible to completely repel the flavor of penicillin. Flemoxin is well absorbed, and you can take the drug at any time, either on an empty stomach or after a meal. Already a day after using the drug, a patient with sore throat feels a significant relief, in the form of improved general well-being, improved swallowing and reduced pain in the throat. Amoxicillin has relevant side effects, among which the most common are various allergic reactions, such as skin itching or urticaria, but they occur rarely. Note that amoxicillin not protected by clavulanic acid is powerless against particularly resistant bacteria that produce beta-lactamase enzymes. Therefore, it is necessary in the case of Flemoxin ineffectiveness to resort to a combination of amoxicillin with clavulanic acid, using the antibiotic Augmentin, which will be discussed below. Still, that said, Flemoxin Solutab can be considered a universal antibacterial drug that has a broad effect on various microorganisms, high quality, and at the same time not very expensive.

Cefexime (Suprax, Ceforal, Panceph)

Rating: 4.9

Cefexime (Suprax, Ceforal, Panzef)

Cefixime is a modern, third-generation cephalosporin that is widely effective against a variety of angina pathogens. This is a capsulated cephalosporin, which is quite rare: usually most cephalosporins are intramuscularly administered drugs. But Suprax by the Hungarian company Gedeon Richter is produced in 200 and 400 mg capsules and has a pronounced bacteriostatic effect. It stops germs from multiplying but does not destroy their cells, thus preventing a massive release of antigens and toxins to the outside so as not to cause infectious-toxic shock.

Antibiotic Suprax is very well prescribed for children, for different types of angina, as well as a reserve antibiotic. Cefixime is used if you are intolerant to penicillins, and for children Suprax is not available in capsules, but in syrup with a bright strawberry flavor that children love very much. It is known that after sore throat there is bacterial bronchitis, when the patient is disturbed by cough with the discharge of purulent sputum, Suprax copes well with bronchitis as well. This is a modern antibiotic, and it is no more expensive than Sumamed. A pack of 6 capsules of 400 mg costs about 600 rubles. In pharmacies.

Advantages and disadvantages

Suprax is a modern oral 3rd generation cephalosporin that works quickly and effectively. The antibiotic is quickly absorbed and excreted slowly, which is why it can be used for various sore throats, both follicular and lacunar, just once daily. Some believe that Suprax often develops allergic reactions, hives and skin itching, but not everyone agrees. Most people tolerate the antibiotic well, including children. Suprax is an affordable, high-quality and relatively inexpensive drug, this antibiotic is effective for all forms of angina and its complications.

Spiramycin (Rovamycin)

Rating: 4.9

Spiramycin (Rovamycin)

Spiramycin, which is produced by the French company Sanofi Aventis, is another excellent representative of an antibiotic that is effective against various types of sore throats. It is not prescribed in the first place, it is a reserve antibiotic, which can be used if the patient is allergic to penicillins, or even to cephalosporins, that is, he can not for any reason take either Augmentin, or Flemoxin solutab, or Suprax. In this case, Rovamycin will fight sore throat perfectly if taken in tablets. Each tablet contains 1.5, or 3 million. units, And for 16 of these pills (1.5 million.) will have to pay from 1100 to 1700 rubles.

Rovamycin is a macrolide that copes with both Gram-positive and Gram-negative aerobes. They include those germs that most often cause sore throat, pharyngitis, and inflammatory respiratory diseases. The drug is also indicated for the treatment of beta-hemolytic streptococcal infections, sinusitis, community-acquired pneumonia, and atypical chlamydia and mycoplasma pneumonia. The drug is prescribed in amounts of 6 to 9 million. units per day in three doses. This means that you need to take 4 to 6 pills of the existing dosage each day. Accordingly, such a package is enough for 2-3 days of treatment, and the course of treatment should last at least a week.

Advantages and disadvantages

It is clear that the disadvantage of the drug will be its high cost. Of the side effects most often occurs rash, nausea, but this is a dose-dependent effect that quickly passes. It is contraindicated with Rovamycin in children under 6 years of age when it comes to 1.5 mil tablets. units. This drug is indeed a “super heavy artillery,” but should be held in reserve for the time being.

Amoxicillin+clavulanic acid (Augmentin, Amoxiclav, Arlet)

Rating: 4.8

Amoxicillin+clavulanic acid (Augmentin, Amoxiclav, Arlet)

Many microbes have learned to fight penicillins, and other “simple” antibiotics, including amoxicillin, with the help of special enzymes: beta-lactamases, making these antibiotics harmless. If the work of these enzymes is stopped, that is, if a beta-lactamase inhibitor is introduced into the amoxicillin antibiotic, then the result will be a protected antibiotic, and clavulanic acid is such an inhibitor. Therefore, if you combine amoxicillin with clavulanic acid, you get the highly effective Augmentin.

One tablet may contain either 250mg or 500 mg of amoxicillin and the same amount of clavulanic acid (125 mg). As a result, Augmentin, which is manufactured by Smithk

  • ne or Glaxo Wellcome from the UK, will cost, on average, 300 rubles for 14 tablets. This price is for a package of 875 mg amoxicillin. This drug is indicated to fight a variety of microbes, including the treatment of various forms of angina, acute and chronic tonsillitis. The drug should be prescribed to adults and children over 12 years of age 1 tablet of 250 mg amoxicillin three times a day. Other dosages are also possible, as prescribed by your doctor.

    Advantages and disadvantages

    Clavulanic acid is very good at increasing the strength of amoxicillin against recalcitrant germs, and they have temporarily lost the ability to resist this effective antibiotic. On the plus side, the price of this new and improved medication not only has not increased, but it has even become a little lower. This is dictated by the very wide distribution of this drug, because the high demand has generated even an excessively high supply of various companies, and the drug in the market has simply become plentiful. Also a plus of Augmentin can be considered its speed of action against pathogenic flora, while the disadvantage is the understandable effect, as an antibiotic, on the microflora of the gastrointestinal tract. But this is a fixable thing: after any antibiotic therapy, dysbacteriosis can easily be corrected with bacterial preparations.


    Rating: 4.8


    You can not ignore the oldest, most loyal, tried and tested “friend”: this is the usual benzylpenicillin-sodium, which hospitals are still buying bags of. Specifically, it is a benzylpenicillin sodium salt, and one vial for preparing an intramuscular injection contains 1 million. units. It is an unprotected biosynthetic penicillin that has a bactericidal effect.

    In most cases, it can help with uncomplicated types of angina, because it is active against Gram-positive bacteria. If it is possible to give intramuscular injections at home, this drug is “cheap and easy” to treat non-serious angina and other similar diseases, starting from pneumonia, endocarditis, and ending with skin, mucosa, and soft tissue infections.

    Intramuscularly it should be administered to adults as prescribed by the doctor, but for sore throats it usually requires 6 vials a day, for a week. The cost of this medication is really popular: one bottle will cost in online pharmacies from 6 rubles 50 kop. per unit. A course of treatment, respectively, will cost about 300 rubles.

    Advantages and disadvantages

    The disadvantage of this drug is a rather weak effect in the severe course of angina. After all, germs have been accustomed to this antibiotic for decades. If we were not in the twenty-first century, but in the forties of the twentieth century, when penicillin was first used, it would be more active than the best modern antibiotics, because germs have never encountered anything like that until now. But at the present time, it is of course quite weak. The second very uncomfortable and unpleasant place is the need to inject every 4 hours, which children do not like at all. As a result of such frequent use there can be infiltrates, on the buttocks you need to apply iodine nets, warm them, respectively, using benzylpenicillin, we are back in the USSR. The only difference will be the disposable needles, as opposed to the blunt, reusable Soviet needles. But with all this, the low cost of the drug is bribing, and the number of complications and side effects is very low.

    Clacid (Clarithromycin)

    Rating: 4.8

    Clacid (Clarithromycin)

    Clacid, or clarithromycin, is a highly effective modern antibiotic manufactured in Italy by Abbott that comes in both granules and tablets. 14 pills of 500 mg each will cost, on average, 750 rubles. It is a semi-synthetic macrolide that is highly effective against many microorganisms that cause angina and pathological inflammation of the mucosa of the upper respiratory tract and nasopharynx. Clacid is particularly effective against mycoplasmosis and legionellosis pathogens. But it is also quite useful for different kinds of angina, including when beta-lactam antibiotics are ineffective. The drug, in addition to angina, is prescribed for maxillitis and other sinusitis, bronchitis and pneumonia, skin and soft tissue infections, acute otitis media. The maximum dosage is 500 mg twice a day, with a starting dose of 500 mg once a day. Clacid can be used both in adults and children, except during breast-feeding.

    Advantages and disadvantages

    The drug is very effective, but the most common side effects are headaches, rash, sweating, diarrhea, and taste disorders. Sometimes there is even a liver enzyme abnormality, but usually after a few days it goes away soon. Clacid should not be used in conjunction with statins, colchicine, low potassium levels, and certain other conditions diagnosed by a doctor. Clacid is a powerful antibiotic, and only a doctor should treat with it, but the effect of treatment of angina will be very good.

    Cefotaxime (Claforan)

    Rating: 4.8

    Cefotaxime (Claforan)

    Telling about the domestic benzylpenicillin, which is injected into the ass 6 times a day, we can also say about cefotaxime (Claforan), which is produced in Turkey. It is clearly more highly effective and is a 3rd generation cephalosporin. The drug destroys a wide range of microorganisms, including resistance to microbes that secrete beta-lactamase, for example, if penicillins, including semisynthetic penicillins, were ineffective. There are some germs that are resistant to this drug, but these are acinetobacter, listeria, and clostridia, which almost never cause angina. Claforan is indicated, except for angina, for the treatment of respiratory and urinary tract infections, endocarditis, septic states, bone and joint infections.

    The drug is administered intramuscularly, in a single dose of 1g, that is, one vial at 12-hour intervals, for uncomplicated sore throat. In the case of moderately severe angina, Claforan is administered every 8 hours, that is, three times a day, and in the case of a severe course, a single dose of 2 vials (2 grams) is administered, shortening the interval between injections to 6 hours, approaching the frequency of administration to benzylpenicillin. Claforan costs 175 rubles. per vial, so 1 day of treatment of angina with this antibiotic costs about the same for uncomplicated angina as a whole week of treatment with domestic benzylpenicillin.

    Advantages and disadvantages

    Certainly Claforan is a more highly effective antibiotic than benzylpenicillin, if only because it is resistant to the action of beta-lactamases. Claforan is quite painful when injected intramuscularly, so it is desirable to inject it not with saline, but with a solution of novocaine or lidocaine, 1% solution. The drug is contraindicated in children under two years of age, and of the side effects noted are allergic reactions, nausea, increased creatinine levels. Therefore, this drug should be carefully prescribed in patients with possible renal dysfunction. Claforan should also not be prescribed for people with severe forms of intracardiac blockage, as well as in severe heart failure and hypersensitivity to local anesthetics used in the form of a solvent for intramuscular injections.

    Josamycin (Wilpafen solutab)

    Rating: 4.8

    Josamycin (Wilprafen solutab)

    The medicine with that pretty name is jozamycin, sweet pills that smell like strawberries. Josamycin is a European quality antibiotic that is produced in France by Astellas Pharma.

    Ten of these tablets of 1 g will cost from 600 to 770 rubles in the summer of 2020. This medicine belongs to the macrolide group of antibiotics. In normal combinations, Vilprafen acts by inhibiting the reproduction of microbes, in high combinations it produces a bactericidal effect. The drug shows high activity against Gram-positive and Gram-negative aerobes, which are the microbes that cause different types of acute tonsillitis, or sore throat. In addition to sore throats, it can treat severe forms of pharyngitis, maxillary sinusitis, laryngitis, scarlet fever, otitis media, and other serious diseases, even diphtheria in combination with an anti-diphtheria serum. The dosage is usually prescribed by the doctor, but classically adults are put 1 g per day in 2-3 intakes, the duration of treatment depends on the indications and the severity of the condition.

    Advantages and disadvantages

    Josamycin is a modern antibiotic that can be prescribed as a second-line drug for angina, both catarrhal and purulent: follicular and lacunar forms. Josamycin may have side effects, but they are not very pronounced and depend on the dose. When treating sore throat with jozamycin, you should not rely on the fact that it is a strong and modern antibiotic, and only pills can cope with the disease. Obligatorily, with any antibiotic prescribed, local treatment is necessary: gargling, resorption of lollipops with antiseptics, irrigation and washing of the tonsils with antibacterial drugs to create an effective bactericidal concentration both outside, on the surface of the tonsils, and in the blood.

    Midekamycin (Macropen)

    Rating: 4.8

    Midekamycin (Macropin)

    Finally, to conclude a review of effective and well-known antibiotics for the treatment of various types of sore throats, we must name midecamycin, under the commercial name of Macropen. Of course, there are other names from other manufacturers. This particular midekamycin is produced by KRKA from Slovenia, and it is inexpensive. For 16 pills of 400 mg you should pay from 200 to 500 rubles.

    Midekamycin refers to macrolides – antibiotics that fight microbes by destroying their cell walls, disrupting protein synthesis in them. In low doses, it stops the development of pathogens, and in high doses it destroys. Macropen is indicated in the treatment of angina if there is an allergy, or intolerance to benzylpenicillin, Flemoxin, or Augmentin. It is, after all, a second-line, reserve drug, and should not be dispensed with. It admirably suppresses the growth of gram-positive and gram-negative bacteria, and even some anaerobes, since clostridia and other anaerobes may be part of the microbial associations that cause angina, especially in the background of severe immune suppression. Macropen is indicated for adults one tablet 3 times a day, and for children 30 to 50 mg per kilogram of weight per day in two doses. Duration of treatment: 1 to 2 weeks.

    Advantages and disadvantages

    This drug is of European quality, it is not expensive, but at the same time one pack of Macropen is enough for 5 days, respectively, for the two-week course three packs are enough, and it will cost 600 rubles at the normal rate. And if you go to a pharmacy that is too expensive, you will overpay more than twice as much. Macropen can cause side effects, of which skin rashes are the most common, but again rare, less than 1% of the time. The drug is contraindicated in patients with hepatic and renal insufficiency and hypersensitivity to midecamycin. A big plus of this medicine is that it can be prescribed to pregnant and lactating women, even with caution. After all, sore throat in pregnant women is a very dangerous disease in terms of the impact on the fetus.

    Ruxithromycin (Rulid, Esparoxy)

    Rating: 4.8

    Roxithromycin (Rulid, Esparoxy)

    Roxithromycin, (the original drug Rulid, produced by French company Sanovi-Aventis refers to macrolide antibiotics). It comes in the form of tablets, 150 mg, in a pack of 10 pieces. Currently on the Russian market there is a German generic of Lindapharm from Germany called Esparoxi. The cost of a pack of 10 tablets is from 230 to 330 rubles. In early 2021.

    Rulid is available for oral administration and is excellent for the treatment of angina caused by most pathogens, including group A beta-haemolytic streptococcus. Of course, there are resistant bacteria and microorganisms, such as mycoplasma and acinetobacter, but they don’t cause angina that often, and acinetobacter – very rarely.

    For sore throats, the drug is prescribed one tablet, 150mg, twice a day, every 12 hours. Thus, the daily dose is 300 mg, and the patient can be given 300 mg per day at once, without dividing the drug into 2 doses.

    Advantages and disadvantages

    Rulid can be used in children, but only from the age of 4. In children with a body weight over 40 kg the dosage is the same as in adults, while in children with a smaller body weight the decision to prescribe roksitromitsin is made by the pediatrician. It is convenient that elderly patients do not need to reduce the dosage and daily dose. It should be remembered that it should be taken before meals and washed down with a large enough amount of water.

    There are side effects, too: most commonly weakness, allergic rash, abdominal discomfort, and increased liver enzymes. The drug is contraindicated in case of co-administration with ergotamine and in case of hypersensitivity to antibiotics from the macrolide group. The doctor must find out whether the patient takes ergotamine and dihydroergotamine, and similar drugs. Otherwise, there may be severe complications, up to limb necrosis. The antibiotic should not be used during pregnancy and lactation, and in the case of hepatic and renal failure, the dose is reduced by half. There is also a group of drug interactions that we will not touch: it is the task of the attending physician to find out, just like determining the duration of a course.

    It should be remembered that in the world, and in Russia, the resistance of the causative agents of angina to macrolides is constantly growing. This applies not only to clarithromycin, but also to roxithromycin, and azithromycin. In the case of detection of macrolide-resistant flora, as well as in the presence of beta-lactamases, lincosamides can be prescribed for allergies, which will be considered antibiotics in reserve: these are Clindamycin and Lincomycin.


    Of course, these antibiotics are not at all the end of the review of medicines for angina. But you must remember that with a purulent process on the tonsils, you must necessarily prescribe antibiotics not only topically, but also internally, or parenterally. After completing a course of antibiotics it is necessary to compensate for the intestinal dysbacteriosis that has developed by prescribing bacterial drugs: Bactisubtil, Linex, Hilac-Forte and others. Vaginal dysbacteriosis is also not excluded, because the blood contains an effective concentration not only to destroy the causative agents of angina, but also normal vaginal flora in women.

    Therefore, appropriate corrective therapy to eliminate vaginal dysbacteriosis and restore its normal biocenosis is necessary. If this is neglected, you can develop the so-called bacterial vaginosis, which involves the development of gardnerellae, and the suppression of normal flora, especially lactobacilli or bacilli Daederlein.

    It is necessary to stop antibiotic therapy in case of sore throat, not only when you feel well, not only after a stable normalization of temperature, elimination of swelling and hyperemia of tonsils, and their complete purulent plaque clearing, but also within the period prescribed by the doctor. Improvement cannot be a reason to stop treatment.

    In this case you can be confident that early or late complications will not appear. Also, the patient should have a urine test to diagnose possible glomerulonephritis, record an EKG, and check for a heart attack after the angina.

    A good reference is given in the article “Antibacterial therapy of streptococcal tonsillitis and pharyngitis”, published in the magazine “Children’s Doctor” in 2000(¹3). In spite of the long history of the published material, some statements are still relevant.

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