steroids for pharyngitis + Centor criteria refresher

STUDY HIGHLIGHTS:

Meta-analysis of 9 RCT's of adults and children using steroids for tonsillitis or pharyngitis 

did find more patients with resolution of pain with steroids at 24 or 48 hours.

All patients received antibiotics, which may have been confounding.

BOTTOM LINE:

consider steroids (maybe prednisone 60mg x1 or 2 days) for adult patients with severe exudative sore throat in conjunction with antibiotics.

Of course, steroids have complications, so consider them when prescribing.

Hayward, G. et.al. (2009). Corticosteroids for pain relief in sore throat: systematic review and meta-analysis. British Medical Journal. 

-----

P.S.

a reminder of the Centor criteria (if you believe in them)

The 4 criteria are: 

• fever
• pharyngeal exudates
• anterior cervical adenopathy
• absence of a cough. 

The presence of a cough, hoarse voice, or conjunctivitis, suggests a viral etiology and is not considered a risk factor for group A beta-hemolytic strep. 

Centor criteria should not be used to predict GABS in children.

• <2 points — No antibiotic or throat culture necessary.
  (Risk of strep infection <10%)
• 2-3 points — Should receive a throat culture and treat with an antibiotic if culture is positive.
• >3 points — Treat empirically with an antibiotic.
  (Risk of strep infection >50%)

Singer JI, Gebhart ME: Sore throat, in Marx JA, Hockberger RS, Walls RM (eds): Rosen's Emergency Medicine Concepts and Clinical Practice, ed 6, St. Louis: Mosby, 2006: 274

Submitted by S. Morris.

Reference(s): hayward study; rosen's chapter (listed above); picture