Corticosteroids as standalone or add-on treatment for sore throat

Sore throat is a common condition. Patients often receive antibiotics for sore throat, which is thought to contribute to resistance to antibiotics in individuals and the community. Sore throats are painful because of the inflammation of the lining of the throat. Corticosteroids reduce inflammation and because they act on the upper respiratory tract in other conditions, may also be beneficial in sore throat.

This systematic review combined the results of eight trials which looked at this question, including a total of 743 participants. Patients taking corticosteroids were three times more likely to experience complete resolution of their sore throat symptoms by 24 hours compared to those taking placebo. In addition, corticosteroids improved the time to onset of symptom relief and the time to complete resolution of symptoms, although the trials were not consistent for these outcomes. Adverse events, relapse rates and recurrence rates were not different for corticosteroid compared to placebo groups. Limitations of the review include the absence of any trials set in Europe and the fact that only two trials addressed the question in children. As all the included trials also gave antibiotics to all participants, we recommend that future research should examine the benefit of corticosteroids in patients who are not also taking antibiotics.

Authors' conclusions: 

Oral or intramuscular corticosteroids, in addition to antibiotics, increase the likelihood of both resolution and improvement of pain in participants with sore throat. Further trials assessing corticosteroids in the absence of antibiotics and in children are warranted.

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Background: 

Sore throat is a common condition associated with a high rate of antibiotic prescriptions, despite limited evidence for the effectiveness of antibiotics. Corticosteroids may improve symptoms of sore throat by reducing inflammation of the upper respiratory tract.

Objectives: 

To assess the clinical benefit and safety of corticosteroids for symptoms of sore throat in adults and children.

Search strategy: 

We searched The Cochrane Library, the Cochrane Central Register of Controlled Trials (CENTRAL 2012, Issue 5) which includes the Acute Respiratory Infections (ARI) Group's Specialised Register, the Database of Reviews of Effects and the NHS Health Economics Database, MEDLINE (1966 to November Week 4, 2012) and EMBASE (1974 to June 2012).

Selection criteria: 

We included randomised controlled trials that compared steroids to either placebo or standard care in adults and children (older than three years of age) with sore throat. We excluded studies of hospitalised participants, those with infectious mononucleosis, sore throat following tonsillectomy or intubation, or peritonsillar abscess.

Data collection and analysis: 

Two review authors independently reviewed and selected trials from searches, assessed and rated study quality, and extracted relevant data.

Main results: 

We included eight trials involving 743 participants (369 children and 374 adults). All trials gave antibiotics to both placebo and corticosteroid groups; no trials assessed corticosteroids as standalone treatment for sore throat. In addition to any effect of antibiotics and analgesia, corticosteroids increased the likelihood of complete resolution of pain at 24 hours by more than three times (risk ratio (RR) 3.2, 95% confidence interval (CI) 2.0 to 5.1, P < 0.001, I2 statistic 44%) and at 48 hours by 1.7 times. Fewer than four people need to be treated to prevent one person continuing to experience pain at 24 hours. Corticosteroids also reduced the mean time to onset of pain relief and the mean time to complete resolution of pain by 6 and 14 hours, respectively, although significant heterogeneity was present. At 24 hours, pain (assessed by visual analogue scores) was reduced by an additional 14% by corticosteroids. No difference in rates of recurrence, relapse or adverse events were reported for participants taking corticosteroids compared to placebo, although reporting of adverse events was poor.

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