{"url":"https://whatshealthyandwhy.com/sore-throat-remedies/gargles-honey-and-lozenges","path":"/sore-throat-remedies/gargles-honey-and-lozenges","alternates":{"json":"https://whatshealthyandwhy.com/api/articles/sore-throat-remedies/gargles-honey-and-lozenges.json","markdown":"https://whatshealthyandwhy.com/sore-throat-remedies/gargles-honey-and-lozenges.md"},"topic":{"slug":"sore-throat-remedies","name":"Sore Throat Remedies","url":"https://whatshealthyandwhy.com/sore-throat-remedies"},"slug":"gargles-honey-and-lozenges","order":1,"title":"Salt Gargles, Honey, and Lozenges for Sore Throat","question":"Do salt-water gargles, honey, and herbal lozenges ease a sore throat?","answer":"Herbal sprays and teas may ease sore throat pain briefly; honey and salt gargles have little direct evidence, and strep or abscess needs a doctor.","description":"What research shows for salt-water gargles, honey, herbal sprays, teas and lozenges on a sore throat, and when strep or an abscess needs a doctor.","confidence":2,"confidenceNote":"Herbal sprays and tea beat placebo in small, short trials, and medicated lozenges give modest benefit in manufacturer-sponsored trials; salt gargles and honey have no sore throat pain trial.","evidenceSummary":{"rctCount":4,"observationalCount":0,"metaAnalysisCount":5,"totalParticipants":"1,000+ in the trials named","replicated":false,"newestStudyYear":2024},"category":{"categoryTitle":"Detox & Heal","categorySlug":"detox-and-heal","subcategoryName":"Home Remedies","subcategorySlug":"home-remedies","url":"https://whatshealthyandwhy.com/explore/detox-and-heal/home-remedies"},"actions":["Gargle warm water or salt water several times a day: plain-water gargling cut upper respiratory infections by a third in 387 healthy adults; salt water is untested for pain [1].","For short-term pain relief, small trials back a sage spray, an echinacea-sage spray or a demulcent herbal tea; expect relief within minutes to hours, not days [4][5][6].","Stir honey into a warm drink for comfort; trials show benefit for cough and cold symptoms, though the pooled outcomes were not throat pain [3]."],"cautions":["Get urgent care for a sore throat with a muffled \"hot potato\" voice, trouble opening the mouth or swallowing, or breathing trouble: a peritonsillar abscess can threaten the airway [10].","Symptoms cannot tell strep from a viral sore throat [9]; if pain is severe or persists, ask for a swab: antibiotics modestly cut symptoms and complications like rheumatic fever [8].","The herbal trials ran 3–7 days, mostly in adults, so ask a clinician before using sprays or teas in pregnancy or for children; never give honey under 12 months [4][5][6][11]."],"simpleText":"Most sore throats clear within a week without antibiotics, so remedies are about comfort [8]. Herbal sprays and teas eased pain in small, short trials [4][5][6]. Honey helps cough and cold symptoms, but the pooled trials did not measure throat pain [3], and salt-water gargles have not been tested for pain at all [1]. Trouble swallowing, opening the mouth or breathing needs urgent care [10].","mediumText":"How it works\n\nMost sore throats get better by themselves\n\nIn antibiotic trials, 82% of people given placebo or no treatment were symptom-free after one week [8]. Strep, the main bacterial cause, makes up a minority of adult sore throats: the Centor analysis assumed 5% to 20% [9]. That is why the goal of a home remedy is comfort while the body clears the infection.\n\nGargles\n\nWe found no trial of salt-water gargling for sore throat pain. Two nearby findings exist. In 387 healthy adults, gargling plain water at least three times a day lowered the rate of first upper respiratory infections over 60 days (rate ratio 0.64) [1]. A small open-label pilot of hypertonic saline nose rinsing plus gargling in people with early colds found illness 1.9 days shorter and needs confirming [2]. Both concern colds rather than throat pain.\n\nHoney\n\nA 2021 meta-analysis of 14 studies found honey better than usual care for combined symptoms and cough in upper respiratory infections; throat pain was not a pooled outcome [3]. Never give honey to a baby under 12 months, because of infant botulism [11].\n\nLozenges\n\nMedicated lozenges with amylmetacresol and dichlorobenzyl alcohol, the Strepsils type, beat plain lozenges for pain at two hours in three manufacturer-sponsored trials of 660 adults; the reviewers called the extra effect modest [7]. Zinc, most often as lozenges, may shorten colds by about 2.4 days at the price of more mild side effects, but those trials measured cold duration, not throat pain [12]. We found no placebo-controlled trial of an herbal lozenge for sore throat.\n\nHerbal sprays and teas\n\nA 15% sage spray beat placebo for throat pain within two hours in a trial of 286 patients [4]. An echinacea-sage spray worked about as well as a chlorhexidine-lidocaine spray in 154 patients [5]. In 60 adults, a demulcent (coating) herbal tea cut pain on swallowing more than a placebo tea within 5 to 30 minutes [6]. See marshmallow root and slippery elm for coating herbs, and honey.\n\nWhen it needs a clinician\n\nAntibiotics lower the chance of lingering sore throat and some complications, but the absolute benefit is modest, and rheumatic fever was rare in the later trials [8]. Individual signs and symptoms cannot reliably separate strep from other sore throats, so clinicians use a scoring rule such as Centor, or a swab [8][9]. A peritonsillar abscess brings fever, sore throat, trouble swallowing, trouble opening the mouth and a \"hot potato\" voice, and can block the airway [10].","deepText":"The evidence in detail\n\nGargling and saline\n\nSatomura and colleagues randomized 387 healthy volunteers aged 18 to 65 to water gargling, povidone-iodine gargling or usual care for 60 days over a winter. The incidence of a first upper respiratory infection was 0.26 episodes per 30 person-days in controls and 0.17 with water, a rate ratio of 0.64 (95% CI 0.41 to 0.99); povidone-iodine did not help (0.89; 95% CI 0.60 to 1.33). Symptoms were self-recorded, and this tested prevention, not treatment of a sore throat [1]. Ramalingam and colleagues randomized 68 adults within 48 hours of a cold to hypertonic saline nasal irrigation and gargling or usual care. In the 61 followed up, illness was 1.9 days shorter (p=0.01), over-the-counter medicine use was 36% lower and household transmission 35% lower, but the trial was open-label and the authors called for a larger one [2].\n\nHoney\n\nAbuelgasim and colleagues pooled 14 studies. Against usual care, honey improved a combined symptom score (mean difference -3.96; 95% CI -5.42 to -2.51; 3 studies), cough frequency (standardized mean difference -0.36; 8 studies) and cough severity (-0.44; 5 studies). Two placebo-controlled studies pooled for combined symptoms were not significant (-0.63; 95% CI -1.44 to 0.18), and the authors called for better placebo-controlled trials [3]. Throat pain was not a pooled outcome. The infant botulism warning rests on repeated epidemiologic findings and honey samples that test positive for spores [11].\n\nLozenges and zinc\n\nWeckmann and colleagues found only three eligible trials of AMC/DCBA lozenges against non-medicated lozenges in 660 adults. Pain intensity two hours after use fell more with the medicated lozenge (standardized mean difference -0.6; 95% CI -0.75 to -0.45 on an 11-point scale). Mild side effects, such as headache, cough and mouth irritation, occurred in up to 16% of people in both groups, and every trial was manufacturer-sponsored [7]. The 2024 Cochrane review of zinc included 34 studies and 8,526 participants. For treatment, zinc may shorten a cold (mean difference -2.37 days; 95% CI -4.21 to -0.53; 8 studies, 972 participants; low certainty, with heavy heterogeneity), and non-serious adverse events were probably more common (RR 1.34). For prevention it may make little or no difference (RR 0.93; 95% CI 0.85 to 1.01) [12].\n\nHerbal sprays and tea\n\nHubbert and colleagues used an adaptive two-stage design in 286 patients with viral pharyngitis. After an interim analysis picked the 15% spray as most promising, it was significantly better than placebo for the reduction of throat pain over the first two hours, with only mild dryness or burning [4]. Choosing the best dose at an interim look may make a result look better than a fixed-dose trial would. Schapowal's double-dummy trial in 154 patients (133 analyzed) from 11 Swiss practices found response rates of 63.8% for echinacea-sage and 57.8% for chlorhexidine-lidocaine, a comparison that cannot show either beats placebo [5]. Brinckmann's trial in 60 adults compared Throat Coat tea with placebo tea; the summed pain-intensity difference favored the tea (-43.8 versus -16.5; p=0.012), with differences from 5 to 30 minutes after a dose [6]. All three were short and small.\n\nAntibiotics and diagnosis\n\nThe 2021 Cochrane review included 29 trials with 15,337 cases. Antibiotics reduced sore throat at day three (RR 0.70; 95% CI 0.60 to 0.80; 3,730 participants) and at one week (RR 0.50; 95% CI 0.34 to 0.75), but 82% of controls were symptom-free by one week. They cut quinsy (Peto OR 0.16) and acute rheumatic fever within two months (OR 0.36), yet most trials date from the 1950s, when rheumatic fever was far more common [8]. A meta-analysis of 21 studies and 4,839 adults found that individual signs shift the odds of strep only slightly (positive likelihood ratios 1.45 to 2.33); a Centor score of 3 or more had specificity 0.82, giving a 12% to 40% probability of strep where prevalence is 5% to 20% [9]. A peritonsillar abscess is the most common deep head and neck infection, and treatment needs drainage and antibiotics [10].\n\nWhere the evidence conflicts\n\nHoney and salt have long use but no direct trial for throat pain. The herbal products have positive trials, but they are small, short, and in forms (sprays, one branded tea) that are hard to generalize, and one had no placebo arm [5]. The medicated lozenge advantage is modest and rests on manufacturer-funded trials [7]. A plain-water gargle prevented infections in one trial while povidone-iodine did not, which hints that any benefit is not simply antiseptic [1].\n\nBottom line\n\nConfidence is low (2 of 5). Some herbal sprays and teas may give brief relief [4][5][6], and medicated lozenges add a modest effect over plain ones [7]. Salt-water gargles and honey are comforting, low-cost habits whose benefit for sore throat pain is untested [1][3]. Antibiotics are for confirmed or severe bacterial cases, and trouble swallowing or breathing is an emergency [8][10].","deepTruncated":false,"references":[{"id":"1","title":"Prevention of upper respiratory tract infections by gargling: a randomized trial","authors":"Satomura K, Kitamura T, Kawamura T, et al.","year":2005,"journal":"Am J Prev Med","pmid":"16242593","url":"https://pubmed.ncbi.nlm.nih.gov/16242593/"},{"id":"2","title":"A pilot, open labelled, randomised controlled trial of hypertonic saline nasal irrigation and gargling for the common cold","authors":"Ramalingam S, Graham C, Dove J, et al.","year":2019,"journal":"Sci Rep","pmid":"30705369","url":"https://pubmed.ncbi.nlm.nih.gov/30705369/"},{"id":"3","title":"Effectiveness of honey for symptomatic relief in upper respiratory tract infections: a systematic review and meta-analysis","authors":"Abuelgasim H, Albury C, Lee J","year":2021,"journal":"BMJ Evid Based Med","pmid":"32817011","url":"https://pubmed.ncbi.nlm.nih.gov/32817011/"},{"id":"4","title":"Efficacy and tolerability of a spray with Salvia officinalis in the treatment of acute pharyngitis - a randomised, double-blind, placebo-controlled study with adaptive design and interim analysis","authors":"Hubbert M, Sievers H, Lehnfeld R, et al.","year":2006,"journal":"Eur J Med Res","pmid":"16504956","url":"https://pubmed.ncbi.nlm.nih.gov/16504956/"},{"id":"5","title":"Echinacea/sage or chlorhexidine/lidocaine for treating acute sore throats: a randomized double-blind trial","authors":"Schapowal A, Berger D, Klein P, et al.","year":2009,"journal":"Eur J Med Res","pmid":"19748859","url":"https://pubmed.ncbi.nlm.nih.gov/19748859/"},{"id":"6","title":"Safety and efficacy of a traditional herbal medicine (Throat Coat) in symptomatic temporary relief of pain in patients with acute pharyngitis: a multicenter, prospective, randomized, double-blinded, placebo-controlled study","authors":"Brinckmann J, Sigwart H, van Houten Taylor L","year":2003,"journal":"J Altern Complement Med","pmid":"12804082","url":"https://pubmed.ncbi.nlm.nih.gov/12804082/"},{"id":"7","title":"Efficacy of AMC/DCBA lozenges for sore throat: A systematic review and meta-analysis","authors":"Weckmann G, Hauptmann-Voß A, Baumeister SE, et al.","year":2017,"journal":"Int J Clin Pract","pmid":"28869700","url":"https://pubmed.ncbi.nlm.nih.gov/28869700/"},{"id":"8","title":"Antibiotics for treatment of sore throat in children and adults","authors":"Spinks A, Glasziou PP, Del Mar CB","year":2021,"journal":"Cochrane Database Syst Rev","pmid":"34881426","url":"https://pubmed.ncbi.nlm.nih.gov/34881426/"},{"id":"9","title":"Predicting streptococcal pharyngitis in adults in primary care: a systematic review of the diagnostic accuracy of symptoms and signs and validation of the Centor score","authors":"Aalbers J, O'Brien KK, Chan WS, et al.","year":2011,"journal":"BMC Med","pmid":"21631919","url":"https://pubmed.ncbi.nlm.nih.gov/21631919/"},{"id":"10","title":"Peritonsillar Abscess","authors":"Galioto NJ","year":2017,"journal":"Am Fam Physician","pmid":"28409615","url":"https://pubmed.ncbi.nlm.nih.gov/28409615/"},{"id":"11","title":"Association between honey consumption and infant botulism","authors":"Tanzi MG, Gabay MP","year":2002,"journal":"Pharmacotherapy","pmid":"12432974","url":"https://pubmed.ncbi.nlm.nih.gov/12432974/"},{"id":"12","title":"Zinc for prevention and treatment of the common cold","authors":"Nault D, Machingo TA, Shipper AG, et al.","year":2024,"journal":"Cochrane Database Syst Rev","pmid":"38719213","url":"https://pubmed.ncbi.nlm.nih.gov/38719213/"}],"wordCount":1284,"source":{"path":"src/content/topics/sore-throat-remedies/gargles-honey-and-lozenges.md"},"citeAs":"“Do salt-water gargles, honey, and herbal lozenges ease a sore throat?.” What's Healthy and Why. https://whatshealthyandwhy.com/sore-throat-remedies/gargles-honey-and-lozenges","notice":"General information backed by peer-reviewed research, not medical advice."}