Magdy W. Attia, MD, FAAP, FACEP
What are the efficacy and safety of corticosteroids for reducing symptoms in adults and children with sore throat?
Included studies compared corticosteroids, alone or combined with another treatment, with placebo in children > 3 years of age and adults who had sore throat (pharyngitis, clinical signs of acute tonsillitis, or the clinical syndrome of sore throat). Exclusion criteria were infectious mononucleosis, peritonsillar abscess, sore throat after tonsillectomy or intubation, or studies of hospitalized patients (other than emergency department outpatients). Outcomes included patient-reported symptom improvement or resolution, pain reduction, and adverse events.
MEDLINE (to May 2012); EMBASE/Excerpta Medica (to Jun 2012); Cochrane Central Register of Controlled Trials, Acute Respiratory Infections Group Specialised Register, Database of Abstracts of Reviews of Effects, and NHS Health Economics Database (Cochrane Library, 2012, Issue 5); World Health Organization International Clinical Trials Register (to Jun 2012); and reference lists were searched for randomized controlled trials (RCTs). 8 RCTs (n = 743) met inclusion criteria: 2 included only children (age 5 to 18 y), 2 included only adults (age 18 to 65 y), and 4 included children and adults. 6 RCTs used dexamethasone, 1 used betamethasone, and 1 used prednisone; 3 administered steroids intramuscularly, 4 orally, and 1 used both methods; 6 used a single dose of corticosteroids. All RCTs used antibiotics in both the corticosteroid and placebo groups. 6 RCTs used adequate allocation concealment, 3 used blinding for outcome assessors, and all 8 were described as double-blind and obtained outcome data for > 80% of participants.
Meta-analysis showed that corticosteroids were better than placebo for complete pain resolution at 24 and 48 hours and absolute pain reduction at 24 hours (Table). Onset of pain relief was faster with corticosteroids than placebo (Table). Limited data were reported on adverse events: 3 RCTs reported no treatment-related side effects, and 1 RCT reported no difference between groups for peritonsillar abscess (2% overall) or hospitalization for fluid rehydration (4% overall).
Adding corticosteroids to antibiotics improves pain relief in patients with sore throat.
Corticosteroids vs placebo in children and adults with sore throat*
*Abbreviations defined in Glossary. RBI, NNT, and CI calculated from data in article using a fixed-effect model. Both groups received antibiotics.
†Random-effects model used for meta-analysis.
‡Assessed using visual or color analogue scales or the McGrath scale. Positive scores indicate a benefit for corticosteroids vs placebo.
Attia MW. Review: Adding corticosteroids to antibiotics improves pain relief in patients with sore throat. Ann Intern Med. ;158:JC11. doi: 10.7326/0003-4819-158-6-201303190-02011
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Published: Ann Intern Med. 2013;158(6):JC11.
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