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Antibiotics

Benefit of steroids for sore throat still unclear

Using steroids, rather than antibiotics, for sore throat is marginally more effective after 48 hours, according to a randomised controlled trial.

Close up of sore throat or acute pharyngitis

Source: Dr P Marazzi / Science Photo Library

In a study comparing patients with acute sore throat who had taken a single dose of dexamethasone with those who had taken placebo there was a significant difference in symptom resolution after 48 hours.

Antibiotics are frequently prescribed inappropriately for sore throat in primary care. However, it has been suggested that corticosteroids could provide symptomatic relief and thereby reduce antibiotic use in sore throat.

In a study of 42 family practices in south and west England, published in JAMA[1] (online, 18 April 2017), 565 patients presenting with acute sore throat not requiring antibiotics were randomly assigned to a single oral dose of dexamethasone 10mg or placebo.

The researchers found that there was no difference in the number of patients achieving the primary endpoint, complete resolution of symptoms at 24 hours (22.6 vs 17.7%, respectively). However, at 48 hours the difference between the groups was significant with more in the dexamethasone group experiencing complete resolution than those taking placebo (35.4 vs 27.1%).

Uncertainty remains about the role of corticosteroids in the treatment of sore throat in primary care, the team concludes.

Citation: Clinical Pharmacist DOI: 10.1211/CP.2017.20202693

Readers' comments (1)

  • Sore throat has different etiologies. One etiology is acute allergic reactions which are those likely to benefit from acute steroid treatment. Viral infections, in principle, should rather be treated conservatively, as even with an acute steroid short course treatment, likelihood of immune suppression arises. Sore throat secondary to exposure to irritant fumes-whatever, is a dual situation wherein the benefit of acute steroid treatment remains pending.
    In this study, moreover, it is intriguing to know how was judgment as to a "sore throat not requiring antibiotic" made; were cultures taken, or what?!

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Supplementary images

  • Close up of sore throat or acute pharyngitis

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