Cochrane for Clinicians

Putting Evidence into Practice

Corticosteroids for the Treatment of Sore Throat



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Am Fam Physician. 2014 Jan 1;89(1):14-15.

This clinical content conforms to AAFP criteria for continuing medical education (CME). See CME Quiz Questions.

Author disclosure: No relevant financial affiliations

Clinical Question

Is treating sore throat with corticosteroids safe and effective?

Evidence-Based Answer

In adults with suspected bacterial pharyngitis who require antibiotic therapy, adding a corticosteroid may increase the likelihood of complete pain resolution at 24 hours. Further study is needed to assess the safety of corticosteroids and whether they can be recommended for presumed viral pharyngitis or for children. (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

Pain caused by inflammation from viral or bacterial infection in the oropharynx or tonsils is a common reason that children and adults seek medical care. Many infections are likely caused by rhinovirus, coronavirus, and adenovirus, whereas the most common bacterial pathogen, group A beta-hemolytic streptococcus, is found in 10% of adults and in 15% to 30% of children with sore throat.1,2 Despite limited benefit of antibiotic therapy, prescribing rates remain inappropriately high; 40% to 50% of sore throat visits result in an antibiotic prescription.3 Analgesics have unclear benefit in pain


The practice recommendations in this activity are available at http://summaries.cochrane.org/CD008268.

SOURCE

Hayward G, Thompson MJ, Perera R, Glasziou PP, Del Mar CB, Heneghan CJ. Corticosteroids as standalone or add-on treatment for sore throat. Cochrane Database Syst Rev. 2012;(10):CD008268.

REFERENCES

1. Bisno AL. Acute pharyngitis. N Engl J Med. 2001;344(3):205–211.

2. Linder JA, Bates DW, Lee GM, Finkelstein JA. Antibiotic treatment of children with sore throat. JAMA. 2005;294(18):2315–2322.

3. Li J, De A, Ketchum K, Fagnan LJ, Haxby DG, Thomas A. Antimicrobial prescribing for upper respiratory infections and its effect on return visits. Fam Med. 2009;41(3):182–187.

4. Respiratory tract infections–antibiotic prescribing Prescribing of antibiotics for self-limiting respiratory tract infections in adults and children in primary care. NICE clinical guidelines no. 69. London, U.K.: National Institute for Health and Clinical Excellence; 2008.

5. Shulman ST, Bisno AL, Clegg HW, et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis. 2012;55(10):e86–e102.

These are summaries of reviews from the Cochrane Library.

The series coordinator for AFP is Corey D. Fogleman, MD, Lancaster General Hospital Family Medicine Residency, Lancaster, Pa.

A collection of Cochrane for Clinicians published in AFP is available at http://www.aafp.org/afp/cochrane.


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