Treatment of Sore Throat in Pregnancy

Symptomatic Relief Options

The American College of Obstetricians and Gynecologists recommends acetaminophen (paracetamol) as the preferred analgesic for pain and fever control during pregnancy, due to its established safety profile 1
Saline gargles are a safe and effective option for symptomatic relief of sore throat in pregnant patients, without any fetal risk 1

Oral decongestants should be avoided, especially during the first trimester, as they are associated with fetal gastroschisis, small intestinal atresia, and maternal hypertension, according to the Rhinology guideline society 2, 1, 3
Aspirin is contraindicated in pregnancy due to its Category D classification and potential to cause premature ductus arteriosus closure, as stated by the Rhinology guideline society 2, 4

Penicillin G or ampicillin are the preferred first-line antibiotics for bacterial tonsillitis in pregnant patients, due to their narrow spectrum and established safety profile, as recommended by the American College of Obstetricians and Gynecologists 1
For non-anaphylactic penicillin allergy, first-generation cephalosporins (e.g., cefazolin) are recommended as alternative antibiotics, according to the American College of Obstetricians and Gynecologists 1

Intranasal corticosteroids (budesonide, fluticasone, mometasone) are safe during pregnancy and can be used for associated nasal symptoms, as stated by the American College of Obstetricians and Gynecologists 1, 4, 3
Saline nasal rinses are a safe and effective option for symptom relief of nasal congestion or rhinitis symptoms in pregnant patients, according to the American College of Obstetricians and Gynecologists 4, 3

The first trimester carries the highest risk for medication-induced teratogenicity, so particular caution should be exercised during this period, as recommended by the American College of Obstetricians and Gynecologists 1, 3
The American College of Obstetricians and Gynecologists advises avoiding all oral decongestants during the first trimester due to congenital malformation risks 1, 4

Tetracyclines, aminoglycosides, trimethoprim-sulfamethoxazole, and fluoroquinolones should be avoided during pregnancy, as stated by the American College of Obstetricians and Gynecologists 1
Consultation with obstetrics should be considered for severe infections or complications, according to the American College of Obstetricians and Gynecologists 1

Aspirin is contraindicated throughout pregnancy due to risk of premature ductus arteriosus closure, intrauterine growth restriction, and perinatal mortality, as recommended by the American College of Obstetricians and Gynecologists 5
First-generation antihistamines should be avoided due to their sedative and anticholinergic properties, according to the Rhinology guideline 5