Single low dose of corticosteroids may relieve sore throats
Patients who received a single low dose of corticosteroids were twice as likely to experience pain relief after 24 hours and 1.5 times more likely to have no pain at 48 hours, and the mean time to onset of pain relief was nearly 5 hours earlier.
A single low dose of corticosteroids can provide pain relief in patients with sore throat, with no increase in serious adverse effects, a study found.
To estimate the benefits and harms of using corticosteroids as an adjunct treatment for sore throat, researchers conducted a systematic review and meta-analysis of randomized controlled trials including patients ages 5 years or older treated in ED or primary care settings for clinical signs of acute tonsillitis, pharyngitis, or the clinical syndrome of sore throat.
Ten trials enrolled 1,426 individuals. Outcomes of interest were complete resolution of pain at 24 and 48 hours; mean time to onset of pain relief; mean time to complete resolution of pain; absolute reduction of pain at 24 hours; duration of bad/nontolerable symptoms such as problems eating, drinking, or swallowing; recurrence/relapse of symptoms; days missed from school or work; need for antibiotics; and rate of adverse events related to treatment.
Study results were published by The BMJ on Sept. 20.
Oral dexamethasone (a single dose of 10 mg for adults and 0.6 mg/kg, maximum 10 mg, for children) was the most common intervention (five studies) followed by a single intramuscular injection of dexamethasone (three studies). Patients who received a single low dose of corticosteroids were twice as likely to experience pain relief after 24 hours (relative risk [RR], 2.2; 95% CI, 1.2 to 4.3; risk difference, 12.4%; moderate-quality evidence) and 1.5 times more likely to have no pain at 48 hours (RR, 1.5; 95% CI, 1.3 to 1.8; risk difference, 18.3%; high-quality evidence).
The mean time to onset of pain relief in patients treated with corticosteroids was 4.8 hours earlier (95% CI, −1.9 to −7.8 hours; moderate-quality evidence) and the mean time to complete resolution of pain was 11.1 hours earlier (−0.4 to −21.8 hours; low-quality evidence) than in those treated with placebo. The absolute pain reduction at 24 hours as measured by a Visual Analogue Scale was greater in patients treated with corticosteroids (mean difference, 1.3; 95% CI, 0.7 to 1.9; moderate-quality evidence). The authors described the effects of corticosteroids as “modest.”
“The relative effects were similar across severities, though patients with less severe sore throat had less absolute benefit from corticosteroids,” they wrote. “The balance of benefits and harms therefore almost certainly depends on the severity of the patient's sore throat.”