Clinical Question

Are oral steroids effective in the treatment of acute sore throat in adults?

Bottom Line

A single dose of oral dexamethasone is no more effective than placebo in resolving acute sore throat symptoms at 24 hours in adults who do not receive immediate antibiotic therapy. However, among a multitude of exploratory secondary outcomes, the authors found that, compared with placebo, dexamethasone increased the proportion of patients with symptom resolution at 48 hours (number needed to treat [NNT] = 12; 95% confidence interval [CI], 7 to 146). (Level of Evidence = 1b)

Synopsis

These investigators identified adults, 18 years or older, who presented to primary care offices in England with acute symptoms of sore throat and odynophagia for which the treating clinician did not prescribe immediate antibiotic therapy. Exclusion criteria included the recent use of inhaled or oral steroids, recent adenotonsillectomy, recent use of antibiotics, or a clear alternative diagnosis such as pneumonia. Eligible participants randomly received (concealed allocation assignment) a single dose of dexamethasone (10 mg) or matching placebo; 11 patients were found ineligible and excluded after participation. Treating clinicians could decide to offer no antibiotics (n = 349) or a delayed antibiotic (n = 227). Patients unaware of group assignment self-assessed outcomes including the primary outcome of complete resolution of sore throat symptoms at 24 hours. Secondary exploratory outcomes included complete resolution of sore throat at 48 hours, duration of moderately bad symptoms, time to onset of pain relief and time to complete resolution of symptoms, consumption of delayed antibiotic prescription, time missed from work or education, attendance at or telephone contact with any heath care facility because of the sore throat, and use of over-the-counter medications and/or other prescription medications in the first seven days. Complete follow-up occurred for 94% of participants at one month.

Using intention-to-treat analysis, no significant difference occurred among the steroid group and the placebo group in achieving complete resolution of symptoms at 24 hours. Results were similar between patients who were and were not offered a delayed antibiotic prescription. At 48 hours, significantly more participants who received dexamethasone reported complete resolution of symptoms compared with those who received the placebo (35.4% vs. 27.1%, respectively; NNT = 12; 95% CI, 7 to 146). Neither severity of sore throat at baseline nor a positive throat culture for Streptococcus bacteria on throat swab was related to group differences. No significant differences occurred between the treatment group and the placebo group in other secondary outcomes or serious adverse events.

Study design: Randomized controlled trial (double-blinded)

Funding source: Government

Allocation: Concealed

Setting: Outpatient (primary care)

Reference:HaywardGNHayADMooreMVet alEffect of oral dexamethasone without immediate antibiotics vs placebo on acute sore throat in adults: a randomized clinical trial. JAMA2017;317(15):1535–1543.