Steroids for sore throat?

Researchers have looked into whether corticosteroids are effective at reducing this painful symptom

A new study published in the Journal of the American Medical Association (JAMA) has found that a single steroid capsule was no better than placebo for relieving a sore throat in 24 hours… though many did feel better after a second day.

Dr Gail Hayward of the University of Oxford and colleagues randomly assigned nearly 600 adults with sore throat not requiring immediate antibiotics to a single oral dose of 10mg of dexamethasone or placebo. The trial was conducted in 42 family practices in South and West England.

Of 565 eligible randomised participants (median age, 34 years), 288 received dexamethasone and 277 received placebo.

The researchers found that at 24 hours, participants receiving dexamethasone were no more likely than those receiving placebo to have complete symptom resolution.

Results were similar among those who were not offered an antibiotic prescription and those who were offered a delayed antibiotic prescription.

At 48 hours, more participants receiving dexamethasone than placebo (35% versus 27%) had complete symptom resolution, which was also observed in patients not offered delayed antibiotics.

There were no significant differences in other outcomes such as days missed from work or school and adverse events.

The authors say that there is still no clear role for oral steroids in patients presenting to their GP with a sore throat.

“Our study findings do not support the routine use of steroids for sore throats in primary care,” says Dr Hayward.

“There are some significant downsides to prescribing steroids for sore throat… In the short term they can cause increased appetite, difficulty sleeping and acid reflux. If patients take steroids daily for a longer period of time, this can also result in weaker bones and high blood pressure.”

She adds that patients with heart conditions, diabetes and other medical conditions are at greater risk from using steroids.

“[While] we did find that they improved the chances of complete resolution of symptoms at 48 hours … this needs to be taken in the context of the short – and long-term side effects of steroids, and we don’t think in this context it’s a clinically significant difference.”

Corticosteroids may have clinical benefit when combined with antibiotics for severe sore throat, says Dr Hayward, for example, to reduce hospital admissions of those patients who are unable to swallow fluids or medications.

However to date there having been no trials of corticosteroid use involving these patient groups.

Acute sore throat is one of the most common symptoms among patients presenting to primary care.

The authors point out that in the UK family doctors still prescribe antibiotics to more than half of the patients they see with the symptom – despite national guidelines advising against prescriptions.

Current guidelines recommend either ibuprofen or paracetamol for relief of acute sore throat symptoms, while antibiotics are not advised to be used in patients with less severe presentation of sore throat as most are viral in origin.

“Modest benefits of antibiotics … have to be weighed against side effects, the effect of antibiotics on microbiota, increased antibacterial resistance, medicalisation and costs,” according to the European Society for Clinical Microbiology and Infectious Diseases Sore Throat Guideline Group.

There remains a need to find alternative strategies that reduce symptoms as well as antibiotic consumption, the study concludes.

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