Tonsillopharyngitis - Acute Drug Summary

Last updated: 22 July 2025

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Analgesics (Non-Opioid) & Antipyretics

Content on this page:

Analgesics (Non-Opioid) & Antipyretics

Analgesics (Non-Opioid) & Antipyretics


Drug Dosage Remarks
Aspirin 300-900 mg PO 4-6 hourly
Max dose: 4 g/day
 Adverse Reactions
  • GI effects (GI discomfort, nausea, diarrhea, GI bleeding and ulcers); Hematologic effects (inhibition of platelet aggregation which is reversible except with Aspirin)
Special Instructions
  • To be administered with or after food, milk or antiulcer drugs to prevent GI effects
  • Avoid in patients with peptic ulceration, hypersensitivity to Aspirin or other NSAIDs, including those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by Aspirin or other NSAIDs
  • Use with caution in patients with hypertension, renal, hepatic or cardiac dysfunction, and children
Paracetamol
(Acetaminophen)
 325-650 mg PO 4-6 hourly or
1,000 mg PO 6 hourly
Max dose: 4 g/day 		 Adverse Reactions
  • Hematologic effects (thrombocytopenia, leukopenia, pancytopenia, agranulocytosis)
Special Instructions
  • Use with caution in patients with renal or hepatic dysfunction and alcohol dependence

Antibacterial Combination


Drug Dosage Remarks
Co-trimoxazole (Sulfamethoxazole [SMX] and Trimethoprim [TMP]) 800 mg SMX/160 mg TMP PO 12 hourly
 Adverse Reactions
  • GI effects (nausea/vomiting, anorexia, diarrhea, rarely antibiotic-associated diarrhea/colitis, glossitis); Dermatologic effects (rash, pruritus, photosensitivity);Hypersensitivity effects (rash, Stevens-Johnson syndrome [SJS]); Urogenital effect (crystallization in the urine); Other effects (renal/hepatic effects, aseptic meningitis)
Special Instructions
  • Maintain adequate fluid intake
  • Contraindicated in patients allergic to sulfonamides
  • Use with extreme caution or not at all in patients with hematological disorders especially megaloblastic anemia due to folic acid deficiency
  • Use with caution in patients with renal impairment or severe hepatic dysfunction and with caution in patients with folate deficiency (may consider administration of folinic acid)

Cephalosporins


Drug Dosage Remarks
First Generation Adverse Reactions
  • Hypersensitivity effects (urticaria, pruritus, rash, anaphylaxis); GI effects (diarrhea, nausea/vomiting); Other effect (candidal infections)
  • High doses may be associated with CNS effects (encephalopathy, convulsions)
  • Prolonged prothrombin time, prolonged activated partial thromboplastin time, and/or hypoprothrombinemia (with or without bleeding) have been reported and occur most frequently with N-methylthiotetrazole side chain-containing cephalosporins
Special Instructions
  • May be taken with food to decrease gastric distress
  • Use with caution in patients allergic to Penicillin (there may be a 10% chance of cross-sensitivity) and with renal impairment
Cefadroxil 1 g PO 24 hourly or divided 12 hourly
Cefalexin
(Cephalexin)		 250 mg PO 6 hourly or
500 mg PO 12 hourly
Max dose: 4 g/day
Cefradine 1-2 g/day PO divided 6-12 hourly
Second Generation
Cefaclor 250-500 mg PO 8 hourly or
375 mg PO 12 hourly
Max dose: 4 g/day
Cefotiam 200-400 mg PO 12 hourly
Cefprozil
 500 mg PO 24 hourly 
Cefuroxime  250-500 mg PO 12 hourly
Third Generation
Cefdinir 300 mg PO 12 hourly or
600 mg PO 24 hourly
Cefditoren pivoxil 200 mg PO 12 hourly
Cefixime
 400 mg PO 24 hourly or divided 12 hourly
Cefpodoxime  100 mg PO 12 hourly
Ceftibuten 400 mg PO 24 hourly

Macrolides


Drug Dosage Remarks
Erythromycin 250 mg PO 6 hourly or 500 mg PO 12 hourly
or 25-50 mg/kg/day IV infusion over 20-60 minutes divided 6 hourly		 Adverse Reactions
  • GI effects (nausea/vomiting, abdominal discomfort, diarrhea and other GI disturbances, antibiotic-associated diarrhea/colitis); Other effect (candidal infections)
  • Dose-related tinnitus/hearing loss has occurred with some macrolides
  • Azithromycin and Clarithromycin tend to cause less GI disturbances than Erythromycin
Special Instructions
  • May take with food to decrease gastric distress
  • Use with caution in patients with hepatic dysfunction
Midecamycin 900-1,800 mg/day PO divided 8-12 hourly
Roxithromycin 150 mg PO 12 hourly or 300 mg PO 24 hourly
Spiramycin 6-9 MIU/day PO divided 8-12 hourly
Advanced Macrolides
Azithromycin 500 mg PO 24 hourly x 3 days or
500 mg PO 24 hourly x 1 day followed by
250 mg PO 24 hourly x 4 days
Clarithromycin 250-500 mg PO 12 hourly

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)


Drug Dosage Remarks
Oral
Diclofenac 75-150 mg /day PO
divided 8-12 hourly
Max dose: 150 mg/day		 Adverse Reactions
  • GI effects (GI ulceration/bleeding/perforation, nausea/vomiting, diarrhea, dyspepsia, abdominal pain, anorexia, flatulence); CNS effects (dizziness, headache, vertigo, tinnitus); Hepatic effect (increased transaminases)
Special Instructions
  • Contraindicated in women in the last trimester of pregnancy, patients with active gastric or intestinal ulcer/bleeding/perforation, severe hepatic, renal or cardiac failure
  • Avoid in patients with peptic ulceration, hypersensitivity to Aspirin or other NSAIDs, including those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by Aspirin or other NSAIDs
Ibuprofen
 200-400 mg PO 4-6 hourly as required
Max dose: 3.2 g/day
 Adverse Reactions
  • GI effects (GI discomfort, nausea, diarrhea, GI bleeding and ulcers); Hematologic effects (inhibition of platelet aggregation which is reversible except with Aspirin)
Special Instructions
  • To be administered with or after food, milk or antiulcer drugs to prevent GI effects
  • Avoid in patients with peptic ulceration, hypersensitivity to Aspirin or other NSAIDs, including those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by Aspirin or other NSAIDs
  • Use with caution in patients with hypertension, renal, hepatic or cardiac dysfunction, and children
Topical
Benzydamine 1 lozenge dissolved in mouth 1-2 hourly x ≤7 days
Max dose: 12 lozenges/day or
15 mL gargled for at least 30 seconds 1.5-3 hourly as needed
or
2-4 sprays onto affected area 1.5-3 hourly as needed

Adverse Reactions

  • Local effects (oral numbness, dryness, tingling, warm feeling in mouth, altered taste)

Special Instructions

  • Contraindicated in patients with severe hepatic or renal impairment
  • Avoid in patients with hypersensitivity to Aspirin or other NSAIDs, including those in whom attacks of asthma have been precipitated by Aspirin or other NSAIDs
Flurbiprofen
 1 lozenge dissolved in mouth 3-6 hourly x ≤3 days
Max dose: 5 lozenges/day
or
3 sprays/dose onto affected area 3-6 hourly
Max dose: 5 doses/day

Adverse Reactions

  • GI effects (nausea, diarrhea); CNS effects (dizziness, headache); Local effects (throat irritation, mouth ulcers, oral and oropharyngeal pain, paresthesia, discomfort); Other effects (hypersensitivity reaction, edema)

Special Instructions

  • Discontinue use at first appearance of skin rash, mucosal lesion or any other sign of hypersensitivity or mouth irritation
  • Contraindicated in patients with active or recurrent history of peptic ulcer/hemorrhage and intestinal ulceration, severe hepatic, renal or cardiac failure, and history of GI bleeding/perforation related to previous NSAID therapy

Oral Care*


Drug Indications
Benzoic acid
 Preservative; has antibacterial properties
Borax Has weak bacteriostatic properties 
Eucalyptol Counter irritant
Menthol Used to relieve symptoms of sinusitis, etc
Muramidase
(Lysozyme)		 Mucopolysaccharidase normally present in saliva 
Sodium benzoate
 Preservative; has antibacterial properties
Thymol  Antiseptic
*These agents are found in various throat and mouth combination preparations throughout different countries. They are available as lozenges, paints, mouthwashes, mouth gel, oral solution, throat spray and troche. Please see the latest MIMS for specific formulations and prescribing information.

Other Antibiotics


Drug Dosage Remarks
Lincosamides    
Clindamycin 600-1,800 mg/day PO divided 6-12 hourly Adverse Reactions
  • GI effects (diarrhea, severe antibiotic-related pseudomembranous colitis, nausea/vomiting, abdominal pain, metallic taste); Hypersensitivity effects (rash, urticaria, rarely anaphylaxis); Dermatologic effects (erythema multiforme, exfoliative/vesiculobullous dermatitis); Other effects (polyarthritis, renal dysfunction, thrombophlebitis)
Special Instructions
  • Use with caution in patients with GI disease especially with history of colitis, atopic patients and with renal or hepatic impairment
  • Monitor liver function with prolonged treatment
  • Discontinue if diarrhea occurs
Lincomycin
 500 mg PO 6-8 hourly
Rifamycin
    
Rifampicin Given with Benzathine penicillin G or Penicillin V for carriers:
20 mg/kg PO 24 hourly x4 days		 Adverse Reactions
  • GI effects (nausea/vomiting, anorexia, diarrhea, GI distress, antibiotic-associated diarrhea/colitis); CNS effects (headache, drowsiness, ataxia); Other effects (discoloration of urine and body fluids)
Special Instructions
  • Rifampicin accelerates the metabolism of drugs metabolized by the CYP-450
  • Use with caution in patients with pre-existing liver dysfunction
  • Monitor liver function during therapy in these patients

Other Drugs Acting on the Respiratory System


Drug Dosage Remarks
Pelargonium sidoides 20 mg PO 8 hourly
 Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea, mild gingival bleeding); Hypersensitivity effects (rash, urticaria, pruritus) associated with initial dose
Special Instructions
  • Contraindicated in patients with severe renal and hepatic impairment
  • Use with caution in patients with hematologic disorders and in patients taking anticoagulants
  • After symptoms subside, advise patient to continue use for additional 2 days

Penicillins


Drug Dosage Remarks
Benzathine benzylpenicillin (Benzathine penicillin G) 1,200,000 u IM as a single dose Adverse Reactions
  • Hypersensitivity effects (rash, urticaria, pruritus, anaphylaxis); GI effects (diarrhea, nausea/vomiting); Other effect (candidal infections)
Special Instructions
  • Avoid in patients with Penicillin allergy
  • Use with caution in patients with renal impairment
Penicillin V (Phenoxymethylpenicillin) 125-250 mg PO 6-8 hourly or
250-500 mg PO 4-6 hourly
Aminopenicillins with or without Beta-lactamase Inhibitors
Amoxicillin (Amoxycillin) 250-500 mg PO 8-12 hourly or
875 mg PO 12 hourly
Extended-release: 775 mg PO 24 hourly
Max dose: 4.5 g/day
Amoxicillin/clavulanic acid (Co-amoxiclav, Amoxicillin/clavulanate)
 625 mg PO 8 hourly or
1,000 mg PO 12 hourly
Extended release: 2,000 mg/125 mg PO 12 hourly
Ampicillin
 250 mg-1,000 mg PO 6 hourly
Max dose: 4 g/day 
Ampicillin/sulbactam (Sultamicillin: Prodrug of Ampicillin and Sulbactam)  375-750 mg PO 12 hourly or
1.5-3 g/day IM/IV divided 6 hourly or
1.5-12 g/day IM/IV divided 6-8 hourly
Sultamicillin tosylate (Sultamicillin tosilate)  375-750 mg PO 12 hourly 
Antistaphylococcal Penicillins
Cloxacillin 250-500 mg PO 6 hourly or 500 mg IV 4-6 hourly
Dicloxacillin 125-250 mg PO 6 hourly

Preparations for Oral Ulceration & Inflammation*


Drug Indications
Aminoacridine (Acridine)
 Antiseptic
Amylmetacresol Antiseptic
Amylocaine Local anesthetic
Andrographis paniculata Local anti-inflammatory effect
Azulene Local anti-inflammatory effect
Bacitracin
 Local antibiotic
Benzalkonium chloride  Antiseptic 
Benzethonium chloride  Antiseptic
Benzocaine
 Local anesthetic 
Benzoxonium chloride  Antiseptic 
Biclotymol  Antiseptic 
Carbenoxolone
 Mucosal protectant 
Cetalkonium chloride
 Antiseptic
Cetrimide
 Antiseptic 
Cetrimonium bromide
 Antiseptic 
Cetylpyridinium chloride
 Antiseptic
Chamomille extract
 Local anti-inflammatory effect 
Chlorhexidine  Antiseptic and disinfectant 
Chlorobutanol  Antiseptic and disinfectant
Chloroxylenol  Antiseptic
Choline salicylate  Rubefacient used as analgesic 
Cinchocaine (Dibucaine)  Local anesthetic
Dequalinium  Antiseptic
Dichlorobenzyl alcohol
 Antiseptic 
Domiphen bromide Antiseptic 
Enoxolone  Treatment of non-infective inflammatory disorders of the mouth and throat 
Glycyrrhizin  Local anti-inflammatory effect
Gramicidin  Local antibacterial agent 
Hexetidine
 Bactericidal agent
Hexylresorcinol  Antiseptic 
Hydroxybenzoate
 Antiseptic and preservative
Lidocaine (Lignocaine)
 Local anesthetic
Methylsalicylate  Rubefacient preparation for the relief of pain 
Neomycin  Local antibiotic 
Phenol  Antiseptic and disinfectant
Policresulen
 Antiseptic
Povidone-iodine  Antiseptic and disinfectant 
Salicylic acid  Local analgesic, anti-inflammatory
Sodium salicylate
 Local analgesic, anti-inflammatory
Tyrothricin Local treatment of infection
*These agents are found in various throat and mouth combination preparations throughout different countries. They are available as lozenges, paints, mouthwashes, mouth gel, oral solution, throat spray and troche. Please see the latest MIMS for specific formulations and prescribing information.

Quinolone


Drug Dosage Remarks
Ciprofloxacin 500 mg PO 12 hourly x 10days
 Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea, abdominal pain, dyspepsia); CNS effects (headache, dizziness, sleep disorders, restlessness, drowsiness); Dermatologic effects (rash, pruritus, photosensitivity); Hypersensitivity effects (rash, SJS)
Special Instructions
  • May take with food to decrease gastric distress
  • Do not take with antacids, iron or dairy products
  • Ensure adequate hydration
  • Use with caution in patients with known risk factors for QT interval prolongation, electrolyte imbalance, history of convulsive disorders

Tetracyclines


Drug Dosage Remarks
Doxycycline 200 mg PO as a single dose or divided 12 hourly initially then 100 mg PO 24 hourly Adverse Reactions
  • Dermatologic effect (photosensitivity); GI effects (nausea/vomiting, diarrhea, antibiotic-associated diarrhea/colitis, dysphagia, esophageal ulceration may occur when taken with an insufficient amount of liquid); Other effects (candidal infections, discoloration of teeth, interference with bone growth in young infants/pregnant women)
Special Instructions
  • Take with plenty of fluid while sitting or standing and well before retiring to bed
  • Avoid long exposure to sunlight or tanning beds
  • Avoid in children ≤8 years old and pregnant women, and in patients with systemic lupus erythematosus
  • Use with caution in patients with renal or hepatic impairment
Minocycline 200 mg PO as a single dose or divided 12 hourly initially then 100 mg/day PO divided 6-12 hourly

Disclaimer

All dosage recommendations are for non-elderly adults with normal renal and hepatic function unless otherwise stated. 
Not all products are available or approved for above use in all countries. 
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs. 
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.

Related MIMS Drugs