Clinical Question

Do oral corticosteroids relieve pain in patients with acute sore throat?

Bottom Line

Sore throats are rarely fatal anymore, but there is really no such thing as “just a sore throat.” Whereas antibiotics have no analgesic activity, a single low dose of a corticosteroid such as oral dexamethasone—0.6 mg per kg for children at least five years of age and up to 10 mg for adults—is effective in decreasing pain in the first 24 hours. (Level of Evidence = 1a)

Synopsis

To determine whether an oral corticosteroid aids in symptom resolution, these researchers searched four databases, including Cochrane Central, trial registries, and reference lists of retrieved studies, and identified 10 studies with a total of 1,426 patients five years or older. Two reviewers independently selected the studies for inclusion and abstracted the data, selecting randomized controlled trials that compared one or two daily doses of corticosteroid with standard treatment or placebo in patients who presented to an emergency department or primary care office with clinical sore throat. Five studies evaluated oral dexamethasone, and three studies evaluated a single intramuscular dose of dexamethasone, in addition to antibiotic treatment and analgesic treatment. Onset of pain relief was 4.8 hours faster with the corticosteroid (7.4 vs. 12.3 hours), with more than twice as many patients reporting complete resolution at 24 hours (relative risk = 2.24; 95% confidence interval, 1.17 to 4.29). There was no demonstrated difference in days missed from school or work, and no difference in adverse effect rates between groups.

Study design: Meta-analysis (randomized controlled trials)

Funding source: Self-funded or unfunded

Setting: Various (meta-analysis)

Reference:SadeghiradBSiemieniukRACBrignardello-PetersenRet alCorticosteroids for treatment of sore throat: systematic review and meta-analysis of randomised trials. BMJ2017;358:j3887.