Corticosteroids for sore throat: a mixed bag of results
Oral corticosteroids could be an alternative symptomatic treatment for acute sore throat in adults.
A single dose of oral dexamethasone in adults with an acute sore throat did not increase the proportion of patients who had resolution of symptoms at 24 hours but did have a significant difference at 48 hours compared with placebo, according to a study in JAMA.
Researchers conducted a double-blind, placebo-controlled, randomized trial to assess the clinical effectiveness of oral corticosteroids for acute sore throat in the absence of antibiotics. The study period was from April 2013 to February 2015, and a 28-day follow-up was completed in April 2015. A total of 42 family practices in England enrolled 576 adults who were recruited on the day that the patients presented to a primary care provider with acute sore throat that did not require immediate antibiotic therapy.
The investigators administered a single oral dose of 10 mg of dexamethasone (n=293) or identical placebo (n=283). The primary outcome measure was the proportion of study participants who had complete resolution of their symptoms at 24 hours.
Among the 565 eligible participants who were randomized (median age, 34; 75.2% women), 288 received dexamethasone and 277 received placebo. At 24 hours, 65 patients (22.6%) in the dexamethasone group and 49 (17.7%) in the placebo group achieved complete resolution of symptoms (risk difference, 4.7%; relative risk, 1.28), reported Gail Nicola Hayward, DPhil, MRCGP, from the University of Oxford, United Kingdom, and colleagues.
At 24 hours, participants who received dexamethasone were not more likely than those who received placebo to have complete symptom resolution. However, at 48 hours, 102 participants (35.4%) in the dexamethasone group compared with 75 (27.1%) in the placebo group achieved complete resolution of symptoms (risk difference, 8.7%; relative risk, 1.31). This difference was also observed in patients who were not offered a delayed antibiotic prescription (risk difference, 10.3%; relative risk, 1.37).
“Uncertainty remains about the role of oral corticosteroids for patients presenting in primary care with sore throat,” stated Dr Hayward's group. “Corticosteroids may have clinical benefit in addition to antibiotics for severe sore throat, for example, to reduce hospital admissions of those patients who are unable to swallow fluids or medications. There have been no trials of corticosteroid use involving these patient groups. A recent systematic review of 3 small trials suggests early but unsustained symptomatic benefit in peritonsillar abscess with 1 trial demonstrating a reduction in duration of hospitalization.
“Adverse effects of corticosteroids may be more significant in patients with comorbidities, such as diabetes and heart failure, who were excluded from this trial,” the researchers concluded. “Given that patients could receive a larger cumulative dose of corticosteroids through multiple primary care visits with sore throat, the potential longer-term effects of increased steroid consumption (eg, osteoporosis, hypertension) should also be considered.”
- Hayward GN, Hay AD, Moore MV, et al. Effect of oral dexamethasone without immediate antibiotics vs placebo on acute sore throat in adults: a randomized clinical trial. JAMA. 2017;317(15):1535-1543. doi:10.1001/jama.2017.3417