A study just published on bmj.com reports that when treating adults with severe sore throat, a single dose of corticosteroid drugs together with antibiotics can alleviate pain more rapidly and effectively than with antibiotics alone.

There is no indication this is beneficial for children.

People frequently seek medical care because of sore throat. However antibiotics have only a slight favorable effect in reducing symptoms and fever. High rates of antibiotic prescriptions also lead to resistance. In addition, current guidelines advise that antibiotics should not be prescribed for sore throat.

In order to find out more, Dr Matthew Thompson at the University of Oxford and collaborators considered the premise that corticosteroids could successfully ease symptoms of a sore throat due to their anti-inflammatory effects.

The results of eight trials were analyzed. They compared corticosteroids to placebo in adults or children. Overall, 743 patients were involved in the trial, including 369 children and 374 adults. They all had symptoms of severe sore throat.

In order to reduce partiality, variations in study feature and quality were considered.

Results showed patients given corticosteroids together with antibiotics were three times more likely to report total clearing up of pain after 24 hours than patients given placebo. After 48 hours the effect on pain was less evident. According to the authors, this indicates that a single dose of corticosteroids may be sufficient.

In addition, corticosteroids reduced the average time to pain relief by about six hours. But, the researchers specify that considerable effects were observed only in adult patients and only in those receiving oral corticosteroids. After assessing the trials, it was apparent that the use of simple painkillers made no difference.

The authors explain: “These findings suggest that, in patients with severe sore throat, pain can be reduced and resolution hastened by use of corticosteroids in conjunction with antibiotic therapy.” They write in conclusion: “These results may also help to prevent antibiotic use, particularly in the context of delayed prescribing. Future research should focus on the effect of corticosteroids independent of antibiotics.”

An associated editorial acknowledges that steroids reduce pain in the first day but it cautions about the lack of information on the possible harmful effects.

“Corticosteroids for pain relief in sore throat: systematic review and meta-analysis”
Gail Hayward, academic in general practice, Matthew Thompson, senior clinical scientist, Carl Heneghan, clinical lecturer in general practice, Rafael Perera, medical statistician, Chris Del Mar, dean, faculty of health sciences and medicine, Paul Glasziou, professor of evidence based medicine
BMJ 2009; 339:b2976

“Sore throat in primary care”
Paul Little


Written by Stephanie Brunner (B.A.)