Do salt-water gargles, honey, and herbal lozenges ease a sore throat?

Most sore throats get better by themselves

In antibiotic trials, 82% of people given placebo or no treatment were symptom-free after one week⁸. 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.

Gargles

We 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 confirming². Both concern colds rather than throat pain.

Honey

A 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 outcome³. Never give honey to a baby under 12 months, because of infant botulism¹¹.

Lozenges

Medicated 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 modest⁷. 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 pain¹². We found no placebo-controlled trial of an herbal lozenge for sore throat.

Herbal sprays and teas

A 15% sage spray beat placebo for throat pain within two hours in a trial of 286 patients⁴. An echinacea-sage spray worked about as well as a chlorhexidine-lidocaine spray in 154 patients⁵. In 60 adults, a demulcent (coating) herbal tea cut pain on swallowing more than a placebo tea within 5 to 30 minutes⁶. See marshmallow root and slippery elm for coating herbs, and honey.

When it needs a clinician

Antibiotics lower the chance of lingering sore throat and some complications, but the absolute benefit is modest, and rheumatic fever was rare in the later trials⁸. 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 airway¹⁰.

Gargling and saline

Satomura 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 throat¹. 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 one².

Honey

Abuelgasim 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 trials³. Throat pain was not a pooled outcome. The infant botulism warning rests on repeated epidemiologic findings and honey samples that test positive for spores¹¹.

Lozenges and zinc

Weckmann 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-sponsored⁷. 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.

Herbal sprays and tea

Hubbert 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 burning⁴. 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 placebo⁵. 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 dose⁶. All three were short and small.

Antibiotics and diagnosis

The 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 common⁸. 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 antibiotics¹⁰.

Where the evidence conflicts

Honey 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 arm⁵. The medicated lozenge advantage is modest and rests on manufacturer-funded trials⁷. A plain-water gargle prevented infections in one trial while povidone-iodine did not, which hints that any benefit is not simply antiseptic¹.

Bottom line

Confidence 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 ones⁷. 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.