Corticosteroids for Sore Throat: BMJ Rapid Recommendation
Am Fam Physician. 2018 Jun 15;97(12):821.
Author disclosure: No relevant financial affiliations.
Key Points for Practice
• Single-dose corticosteroids may be used to resolve sore throat symptoms at 48 hours in patients five years and older.
• Shared decision making should be used because corticosteroids do not reduce the chance of recurrence or relapse of symptoms, or days missed from school or work.
From the AFP Editors
Acute sore throat typically resolves after seven to 10 days in adults and two to seven days in children. It can result in missed school or work, but complications are rare. Most guidelines recommend acetaminophen or ibuprofen as a first-line treatment and discourage the use of corticosteroids. However, a large randomized controlled trial found that corticosteroids increased the likelihood of symptom resolution at 48 hours. Based on this study, the BMJ Rapid Recommendations team, a collaboration between BMJ and the MAGIC group, issued a weak recommendation to give a single dose of oral corticosteroids to most patients with acute sore throat.
The recommendation applies to patients at least five years of age with severe or nonsevere sore throat of viral or bacterial etiology who were prescribed immediate or deferred antibiotics. It does not apply to immunocompromised patients or those with infectious mononucleosis, recurrent sore throat, or sore throat after surgery or intubation.
Although corticosteroids are effective for the treatment of sore throat, they do not considerably reduce the severity or duration of pain or improve other patient-oriented outcomes (e.g., time off from work or school, risk of relapse). For this reason, the recommendation to use corticosteroids is weak, and the decision to use these medications should be made jointly between the physician and patient.
The panel identified eight outcomes needed to inform the recommendation: complete resolution of pain, time to onset of pain relief, pain severity, need for antibiotics, days missed from school or work, recurrence of symptoms, duration of bad or intolerable symptoms, and adverse
Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.
This series is coordinated by Sumi Sexton, MD, Editor-in-Chief.
A collection of Practice Guidelines published in AFP is available at https://www.aafp.org/afp/practguide.
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