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Adjuvant Steroid Therapy for Managing Pharyngitis

Am Fam Physician. 2005 Nov 15;72(10):2120-2123.

Patients with acute inflammation of the throat often present to family physicians with significant pain, trismus, difficulty swallowing, and fever. Antibiotic therapy may shorten the duration of symptoms and avert consequences. Kiderman and colleagues studied the effectiveness of adjuvant steroids in relieving acute infectious pharyngitis symptoms.

The randomized controlled study included adult patients who consulted five Israeli general practitioners because of severe sore throat and at least two additional symptoms (e.g., dysphagia, fever, lymphadenopathy, tonsillar or pharyngeal exudates). After assessment, patients were randomized to receive 60 mg prednisone (20 mg three times daily) or three doses of placebo. Antibiotic and other therapy were provided at the physician’s discretion. Approximately one half of the patients received two-day therapy and the remaining patients received one-day therapy. Patients and physicians were blinded to treatment allocation. All patients rated pain on a 10-point visual analog scale at baseline and were interviewed about pain and other symptoms at 8 to 12 hours, 24 hours, 48 hours, and seven days after consultation. After 14 days, patients were interviewed about symptom recurrence. Throat swabs were performed before treatment and at 14 days.

Outcome Measures of Patients Treated with Prednisone or Placebo for Pharyngitis

Prednisone (n = 40) Placebo (n = 39) P value Difference of means 95% CI

Mean (SD) throat pain score*

12 hours

3.9 (2.5)

5.9 (2.3)

< 0.001

–2.02

–0.9 to –3.35

24 hours

2.4 (2.6)

4.5 (2.9)

0.002

–2.1

–0.77 to –3.22

48 hours

1.8 (2.5)

2.6 (2.6)

0.13

–0.8

–0.04 to 2.04

72 hours

1.2 (2.3)

1.2 (1.7)

0.9

0

–1.2 to 1.1

Pain-free patients (%)

Odds ratio

12 hours

27.5

2.6

0.006

0.07

0 to 0.58

24 hours

42.5

10.3

0.003

0.15

0.04 to 0.58

48 hours

57.5

33.3

0.053

0.37

0.13 to 1.02

72 hours

72.5

53.8

0.13

0.44

0.15 to 1.26

Patients with recurrence at follow-up (%)

2 weeks

2.6

13.2

0.12

0.18

0.01 to 1.75


*— According to 10-point visual analog scale.

CI = confidence interval; SD = standard deviation.

Adapted with permission from Kiderman A, Yaphe J, Bregman J, Zemel T, Furst AL. Adjuvant prednisone therapy in pharyngitis: a randomised controlled trial from general practice. Br J Gen Pract 2005;55:221.

Outcome Measures of Patients Treated with Prednisone or Placebo for Pharyngitis

View Table

Outcome Measures of Patients Treated with Prednisone or Placebo for Pharyngitis

Prednisone (n = 40) Placebo (n = 39) P value Difference of means 95% CI

Mean (SD) throat pain score*

12 hours

3.9 (2.5)

5.9 (2.3)

< 0.001

–2.02

–0.9 to –3.35

24 hours

2.4 (2.6)

4.5 (2.9)

0.002

–2.1

–0.77 to –3.22

48 hours

1.8 (2.5)

2.6 (2.6)

0.13

–0.8

–0.04 to 2.04

72 hours

1.2 (2.3)

1.2 (1.7)

0.9

0

–1.2 to 1.1

Pain-free patients (%)

Odds ratio

12 hours

27.5

2.6

0.006

0.07

0 to 0.58

24 hours

42.5

10.3

0.003

0.15

0.04 to 0.58

48 hours

57.5

33.3

0.053

0.37

0.13 to 1.02

72 hours

72.5

53.8

0.13

0.44

0.15 to 1.26

Patients with recurrence at follow-up (%)

2 weeks

2.6

13.2

0.12

0.18

0.01 to 1.75


*— According to 10-point visual analog scale.

CI = confidence interval; SD = standard deviation.

Adapted with permission from Kiderman A, Yaphe J, Bregman J, Zemel T, Furst AL. Adjuvant prednisone therapy in pharyngitis: a randomised controlled trial from general practice. Br J Gen Pract 2005;55:221.

The patients assigned to placebo were similar to patients in the treatment group in all important variables. The mean age was 34 years, and the mean initial pain score was between 7 and 8. All 79 patients completed follow-up. Pain scores were significantly lower in the treatment group after 12 and 24 hours but not thereafter (see accompanying table). Fifty-seven percent of patients in the treatment group were pain free at 48 hours compared with 33 percent in the placebo group. The number of patients reporting recurrence within two weeks showed no statistically significant difference in the two groups. Significantly more patients who took steroids for two days achieved symptom relief than patients who took steroids for one day.

The authors conclude that short-acting adjuvant steroid therapy significantly relieved symptoms of acute painful pharyngitis with no apparent adverse effects.

Kiderman A, et al. Adjuvant prednisone therapy in pharyngitis: a randomised controlled trial from general practice. Br J Gen Pract. March 2005;55:218-21.


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