steroids and sore throat

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REVIEW ARTICLE:

--includes 5 adult trials of IM vs oral steroids for acute pharyngitis

--suggested earlier reduction of pain and shorter time to complete relief as well as 3 pediatric trials using oral dex (0.6 mg/kg to a max of 10 mg) as a single dose or given over 3 days showed earlier pain reduction compared to controls

--no benefit to 3 day vs. single dose

META-ANALYSIS:

--includes 8 RCT’s comparing systemic corticosteroids and placebo

--when given with antibiotics, patients who received steroids had an average onset of pain relief 6.3 hours earlier

INTRAMUSCULAR STEROIDS:

--turkish study; single dose IM dex vs. placebo for patients with 2+ Centor criteria

--average onset to pain relief of 8.1 hrs in steroid group vs. 19.9 hrs in placebo group

--complete pain relief of 28.9 hrs (steroid) vs 53.7 hrs (placebo)

PO vs. IM STEROIDS:

--single dose oral prednisone vs IM dexamethasone

--no difference in pain scores or number of hours to relief of pain

10-SECOND RECAP:

--steroids in acute pharyngitis: hastens pain relief by about 6-24 hours (vs. placebo)

--single dose probably just as good as 3-day course

--dexamethasone IM vs. prednisone PO: works about the same

Submitted by F. DiFranco.

Reference(s): Hayward, G., et al. Corticosteroids for pain relief in sore throat: systematic review and meta-analysis. British Medical Journal. 339:b2976, Aug. 2009; Korb, K., et al. Steroids as adjuvant therapy for acute pharyngitis in ambulatory patients: a systematic review. Annals of Family Medicine. 8(1):58, Jan.-Feb. 2010; Marvez-Valls, E., et al. A randomized clinical trial of oral versus intramuscular delivery of steroids in acute exudative pharyngitis. Academic Emergency Medicine. 9(1):1, Jan. 2002; Tasar, A., et al. Clinical efficacy of dexamethasone for acute exudative pharyngitis. Journal of Emergency Medicine. 35(4):363, Nov. 2008; picture