Steroids as Adjuvant Therapy for Acute Pharyngitis in Ambulatory Patients: A Systematic Review

Katrin Korb, MD; Martin Scherer, MD, PhD; Jean-François Chenot, MD, MPH

Disclosures

Ann Fam Med. 2010;8(1):58-63. 

In This Article

Abstract and Introduction

Abstract

Purpose This review summarizes the evidence regarding the efficacy of adjuvant steroids for pain reduction in acute pharyngitis.
Methods We searched for randomized controlled trials, using MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews, published between 1966 and December 2008. Two reviewers assessed the quality of each retrieved article and summarized the data.
Results Our review found 8 relevant randomized controlled trials (RCTs) with a total of 806 patients. There were 5 RCTs with adult patients and 3 with children. All RCTs found a statistically significant faster reduction of pain or complete pain relief from steroid use compared with placebo. The trials used different steroids (dexamethasone, betamethasone, prednisone), and most participants had received antibiotics at least initially. Analgesic medication, such as acetaminophen, was allowed in all studies, but this factor was not always controlled. No serious adverse side effects were reported.
Conclusions Steroids are effective in relieving pain in acute pharyngitis. Although no serious adverse effects were observed, the benefits have to be balanced with possible adverse drug effects. There are safe and effective over-the-counter medications to relieve throat pain. Most patients received concomitant antibiotics; however, reducing the prescription of antibiotics for generally benign upper respiratory tract infection is a public health goal. We therefore recommend further studies to establish both the safety of steroids without antibiotic coverage and the additional benefits of steroids when used with regular administration of over-the-counter analgesic medications.

Introduction

Sore throat is a highly common condition. In a Scottish survey 31% of respondents reported at least 1 episode of sore throat within the last 12 months; most did not seek medical attention.[1] Physicians frequently assume that patients seeking care expect a course of antibiotics. It has been shown, however, that pain relief is more important for patients, and patients who hope for antibiotics may in fact want treatment for pain.[2] Thus, a major treatment goal for patients complaining of sore throat is to relieve pain and alleviate difficulties in swallowing.

Viral or bacterial infections that cause a sore throat generate pain through inflammation of the pharynx and the surrounding lymphatic tissue. Although antibiotic treatment may shorten the duration of symptoms in a bacterial throat infection (from 3.3 to 2.7 days), the benefits are considered moderate.[3] Gargling, drinking warm liquids, and oral antipyretic or analgesic drugs are common supportive treatments available over the counter.[4] The anti-inflammatory action of steroids might be effective to relieve symptoms caused by inflammation and has been studied in other upper respiratory tract infections. Steroids might, therefore, represent a useful clinical option to meet patients' needs. Administering intramuscular or oral steroids for acute pharyngitis is not common practice; however, several randomized controlled trials, mainly from the United States and few other countries (Israel, Turkey), have studied the effectiveness of steroids.

We performed a systematic review of the effects of steroids as adjuvant therapy for acute pharyngitis in ambulatory patients and discuss the implications for practice.

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