Jury Still Out on Steroids Used to Relieve Adult Sore Throat Symptoms.Corticosteroids for a Sore Throat?

December 08, 2022

Jury Still Out on Steroids Used to Relieve Adult Sore Throat Symptoms.Corticosteroids for a Sore Throat? | Clinician Reviews

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Prednisone sore throat.Jury Still Out on Steroids Used to Relieve Adult Sore Throat Symptoms

Corticosteroids as stand-alone or add-on treatment for sore throat | Cochrane

Oxford, U. The answer is mixed, according to a new study appearing in JAMA. University of Oxford—led researchers determined that, as of 24 hours, patients at 42 family practices in South and West England who received dexamethasone had complete symptom resolution at no higher rates than those getting a placebo.

At 48 hours, however, more participants receiving dexamethasone than placebo reported complete symptom resolution, whether or not they were offered delayed antibiotics. Background information in the article describes how corticosteroids inhibit transcription of proinflammatory mediators in airway endothelial cells, which are responsible for pharyngeal inflammation and pain symptoms.

In the study, Treatment Options Without Antibiotics for Sore Throat TOAST , the primary objective was to determine whether adults with acute sore throat not requiring immediate antibiotic therapy would experience one-day symptom reduction with a single dose of oral dexamethasone versus placebo. Results indicate that, at 24 hours, In all eight RCTs, antibiotics were given to those in both the treatment and placebo groups.

In addition, all participants were allowed to use traditional analgesia either acetaminophen or NSAIDs. Corticosteroids oral dexamethasone, oral prednisone, or intramuscular [IM] dexamethasone were used as an adjunctive treatment in all the RCTs. Primary outcomes varied between studies. Four of the eight RCTs included the proportion of patients with improvement or complete resolution of symptoms within 24 to 48 hours.

Mean time to onset of pain relief was the primary outcome in five of the eight studies. Some of the secondary outcomes in the individual trials included relapse rates, adverse events, and days missed from school or work. This Cochrane review found that patients with severe or exudative sore throat benefit from pain reduction with corticosteroids, used as an adjunct to antibiotics and other analgesics without increased risk for harm. Nonetheless, the use of steroids in this patient population would address a practical concern of those seeking symptom relief and has the potential to decrease unnecessary use of antibiotics.

CAVEATS Questions about effects on antibiotic use, heterogeneity The studies in this meta-analysis did not assess whether the use of corticosteroids would reduce unnecessary use of antibiotics, so we cannot conclude that this would be the case. Because the effect was similar in all subgroups analyzed, however, it is reasonable to expect that reduced antibiotic use could be a positive effect.

The main documented benefit was resolution of pain, an important patient-centered outcome that justifies consideration of treating painful pharyngitis with corticosteroids. Skip to main content. Corticosteroids for a Sore Throat?

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Prednisone sore throat

At 48 hours, however, more participants receiving dexamethasone than placebo reported complete symptom resolution, whether or not they were offered delayed antibiotics.

Background information in the article describes how corticosteroids inhibit transcription of proinflammatory mediators in airway endothelial cells, which are responsible for pharyngeal inflammation and pain symptoms.

Corticosteroids oral dexamethasone, oral prednisone, or intramuscular [IM] dexamethasone were used as an adjunctive treatment in all the RCTs. Primary outcomes varied between studies.

Four of the eight RCTs included the proportion of patients with improvement or complete resolution of symptoms within 24 to 48 hours. Mean time to onset of pain relief was the primary outcome in five of the eight studies.

Some of the secondary outcomes in the individual trials included relapse rates, adverse events, and days missed from school or work. This Cochrane review found that patients with severe or exudative sore throat benefit from pain reduction with corticosteroids, used as an adjunct to antibiotics and other analgesics without increased risk for harm. Nonetheless, the use of steroids in this patient population would address a practical concern of those seeking symptom relief and has the potential to decrease unnecessary use of antibiotics.

Because the effect was similar in all subgroups analyzed, however, it is reasonable to expect that reduced antibiotic use could be a positive effect. The main documented benefit was resolution of pain, an important patient-centered outcome that justifies consideration of treating painful pharyngitis with corticosteroids.

Skip to main content. Corticosteroids for a Sore Throat? Clinician Reviews. Pages 1 2 last ».

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Corticosteroids for Sore Throat: BMJ Rapid Recommendation | AAFP.

At 48 hours, A rapid strep test is negative. For this reason, the recommendation to use corticosteroids is weak, and the decision to use these medications should be made jointly between the physician and patient. So is this effect at 48 hours strong enough evidence to warrant a shift to GPs prescribing corticosteroids routinely for sore throat? This series is coordinated by Michael J.

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Click 'Find out more' for information on how to change your cookie settings. Gail Hayward. In the face of mounting pressure to reduce antibiotic prescribing, what alternatives are there for treating the one-in-ten people who visit their doctor each year with this common ailment?

As both a GP and an academic researcher, I see a lot of patients who are suffering with sore throats, and I know that effective alternative treatments to antibiotics would be welcomed by both GPs and patients. While previous research on the subject has suggested a role for corticosteroids, the evidence is yet to be compelling enough to herald a step-change in our approach to acute sore throat.

So along with researchers from the Universities of Oxford, Bristol and Southampton, we set out to shed some light on the issue by examining, for the first time, the effect of a single corticosteroid capsule given to patients in primary care who present with a sore throat. We followed up by text message to find out whether patients were feeling completely better, how long they had moderately bad symptoms for, whether they had time off work, and if they had cashed-in the antibiotic prescription.

After 24 hours, corticosteroids had no effect on sore throat symptoms compared with the control group. This means that on average a doctor would need to prescribe corticosteroids to 12 patients to help 1 additional patient feel better after 48 hours. So is this effect at 48 hours strong enough evidence to warrant a shift to GPs prescribing corticosteroids routinely for sore throat? And then there are the side-effects of corticosteroids to consider — such as changes in mood and increased appetite in the short term, and weaker bones and high blood pressure after using steroids frequently for longer periods of time.

If patients were taking steroid courses for other medical conditions at the same time as visiting their doctor with a sore throat, these longer-term side effects might start to become a concern. We also need to consider whether patients might seek GP appointments more frequently for sore throat if their GP were to prescribe steroids, which could reduce the amount of time GPs have to spend with patients with more serious medical conditions.

While corticosteroids may still play a role in other aspects of sore throat management due to their anti-inflammatory properties, such as for patients seen in hospital settings, or if a patient is unable to swallow or take other medications, GPs should continue to fall back on conventional wisdom for sore throat — over-the-counter painkillers, drinking plenty of fluids and time. Is there a link between antibiotic use in gastrointestinal illness and complications such as arthritis and irritable bowel syndrome?

DPhil student Seun Esan investigates. Readers' comments will be moderated - see our guidelines for further information. Hayward GN. Cookies on this website. Accept all cookies Reject all non-essential cookies Find out more.

News and opinion Opinion: Research and teaching blog Can steroids soothe the thorny issue of acute sore throat? Can steroids soothe the thorny issue of acute sore throat? Share Share Share. What to read next. Read the paper:. More publications. Add comment Please add your comment in the box below.

Physicians may prescribe antibiotics for sore throats, although they have no Similar steroids include prednisone and methylprednisolone. Steroids are not currently recommended for routine use to treat symptoms of sore throat. This Cochrane review found that patients with severe or exudative sore. “Corticosteroids may have clinical benefit in addition to antibiotics for severe sore throat, for example, to reduce hospital admissions of. Sore throats are painful because of inflammation of the lining of the throat. Steroids, or corticosteroids, are medications that can be taken as. Consider prescribing a single dose of corticosteroids for patients with sore throat; this has been found to provide quick pain relief and resolution of. Evidence rating system used? Results also indicate that, in participants not offered delayed antibiotic prescription, the risk difference was Recommendations based on patient-oriented outcomes? Featured Issue Featured Supplements. Key Points for Practice.

Featured Issue Featured Supplements. Oxford, U. The answer is mixed, according to a new study appearing in JAMA. University of Oxford—led researchers determined that, as of 24 hours, patients at 42 family practices in South and West England who received dexamethasone had complete symptom resolution at no higher rates than those getting a placebo. At 48 hours, however, more participants receiving dexamethasone than placebo reported complete symptom resolution, whether or not they were offered delayed antibiotics.

In the study, Treatment Options Without Antibiotics for Sore Throat TOAST , the primary objective was to determine whether adults with acute sore throat not requiring immediate antibiotic therapy would experience one-day symptom reduction with a single dose of oral dexamethasone versus placebo. Results indicate that, at 24 hours, At 48 hours, Results also indicate that, in participants not offered delayed antibiotic prescription, the risk difference was In the U.

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