Corticosteroids for Sore Throat: BMJ Rapid Recommendation | AAFP.Jury Still Out on Steroids Used to Relieve Adult Sore Throat Symptoms

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One dose of a steroid can alleviate the pain—and has the potential to decrease unnecessary use of antibiotics. She has no associated cough.

Examination reveals erythematous posterior oropharynx with exudate. A rapid strep test is negative. The patient says the sore throat is very painful and asks for medication to make it better. What should you prescribe? Most sore throats—particularly in adults—are viral and self-limiting. Do patients want antibiotics, or simply pain relief?

Antibiotics produce only a modest reduction in symptoms of pharyngitis fever and throat soreness , presumably in patients with bacterial infections, and increase the risk for adverse events. A short course of corticosteroids has been used successfully and shown to be safe for conditions such as acute sinusitis, croup, and asthma.

A systematic review suggested that was the case. In all eight RCTs, antibiotics were given to those in both the treatment and placebo groups.

In addition, all participants were allowed to use traditional analgesia either acetaminophen or NSAIDs. Corticosteroids oral dexamethasone, oral prednisone, or intramuscular [IM] dexamethasone were used as an adjunctive treatment in all the RCTs.

Primary outcomes varied between studies. Four of the eight RCTs included the proportion of patients with improvement or complete resolution of symptoms within 24 to 48 hours. Mean time to onset of pain relief was the primary outcome in five of the eight studies. Some of the secondary outcomes in the individual trials included relapse rates, adverse events, and days missed from school or work.

This Cochrane review found that patients with severe or exudative sore throat benefit from pain reduction with corticosteroids, used as an adjunct to antibiotics and other analgesics without increased risk for harm. Nonetheless, the use of steroids in this patient population would address a practical concern of those seeking symptom relief and has the potential to decrease unnecessary use of antibiotics. CAVEATS Questions about effects on antibiotic use, heterogeneity The studies in this meta-analysis did not assess whether the use of corticosteroids would reduce unnecessary use of antibiotics, so we cannot conclude that this would be the case.

Because the effect was similar in all subgroups analyzed, however, it is reasonable to expect that reduced antibiotic use could be a positive effect. The main documented benefit was resolution of pain, an important patient-centered outcome that justifies consideration of treating painful pharyngitis with corticosteroids.

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Prednisone sore throat. Corticosteroids for a Sore Throat?

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Prednisone sore throat. Jury Still Out on Steroids Used to Relieve Adult Sore Throat Symptoms

Editor's Note: The role of shared decision making cannot be overemphasized. Mean time to onset of pain relief was the primary outcome in five of the eight studies. We also need to consider whether patients might seek GP appointments more frequently for sore throat if their GP were to prescribe steroids, which could reduce the amount of time GPs have to spend with patients with more serious medical conditions. And then there are the side-effects of corticosteroids to consider — such as changes in mood and increased appetite in the short term, and weaker bones and high blood pressure after using steroids frequently for longer periods of time. The risks may outweigh the benefits when larger doses are given to patients with multiple episodes of sore throat.

While previous research on the subject has suggested a role for corticosteroids, the evidence is yet to be compelling enough to herald a step-change in our approach to acute sore throat. So along with researchers from the Universities of Oxford, Bristol and Southampton, we set out to shed some light on the issue by examining, for the first time, the effect of a single corticosteroid capsule given to patients in primary care who present with a sore throat.

We followed up by text message to find out whether patients were feeling completely better, how long they had moderately bad symptoms for, whether they had time off work, and if they had cashed-in the antibiotic prescription. After 24 hours, corticosteroids had no effect on sore throat symptoms compared with the control group. This means that on average a doctor would need to prescribe corticosteroids to 12 patients to help 1 additional patient feel better after 48 hours.

So is this effect at 48 hours strong enough evidence to warrant a shift to GPs prescribing corticosteroids routinely for sore throat? And then there are the side-effects of corticosteroids to consider — such as changes in mood and increased appetite in the short term, and weaker bones and high blood pressure after using steroids frequently for longer periods of time. The patient says the sore throat is very painful and asks for medication to make it better. What should you prescribe? Most sore throats—particularly in adults—are viral and self-limiting.

Do patients want antibiotics, or simply pain relief? Antibiotics produce only a modest reduction in symptoms of pharyngitis fever and throat soreness , presumably in patients with bacterial infections, and increase the risk for adverse events. A short course of corticosteroids has been used successfully and shown to be safe for conditions such as acute sinusitis, croup, and asthma.

A systematic review suggested that was the case. 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 effects.

It determined that corticosteroids increase the likelihood of complete resolution of pain at 24 and 48 hours, reduce the severity of pain, and shorten the time to onset of pain relief high- to moderate-quality evidence. However, corticosteroids are unlikely to reduce recurrence or relapse of symptoms or days missed from school or work moderate-quality evidence. A single dose of corticosteroids is not likely to cause serious adverse effects moderate-quality evidence.

The panel was less confident about whether corticosteroids reduced antibiotic use or the average time to complete resolution of pain low-quality evidence. Corticosteroids are typically given as 10 mg of dexamethasone for adults 0. The risks may outweigh the benefits when larger doses are given to patients with multiple episodes of sore throat. To mitigate this issue, clinicians should administer the medication in the office, if possible, or prescribe only one dose per visit.

In the study, Treatment Options Without Antibiotics for Sore Throat TOAST , the primary objective was to determine whether adults with acute sore throat not requiring immediate antibiotic therapy would experience one-day symptom reduction with a single dose of oral dexamethasone versus placebo. Results indicate that, at 24 hours, At 48 hours,

Featured Issue Featured Supplements. Oxford, U. The answer is mixed, according to a new study appearing in JAMA. University of Oxford—led researchers determined that, as of 24 hours, patients at 42 family practices in South and West England who received dexamethasone had complete symptom resolution at no higher rates than those getting a placebo.

At 48 hours, however, more participants receiving dexamethasone than placebo reported complete symptom resolution, whether or not they were offered delayed antibiotics. Background information in the article describes how corticosteroids inhibit transcription of proinflammatory mediators in airway endothelial cells, which are responsible for pharyngeal inflammation and pain symptoms.

In the study, Treatment Options Without Antibiotics for Sore Throat TOASTthe primary objective was to determine whether adults with acute sore throat not requiring immediate antibiotic therapy would experience one-day symptom reduction with a single dose of oral dexamethasone versus placebo. Results indicate that, at 24 hours, At 48 hours, Results also indicate that, in participants not offered delayed antibiotic prescription, the risk difference was In the U.

Physicians may prescribe antibiotics for sore throats, although they have no Similar steroids include prednisone and methylprednisolone. Steroids are not currently recommended for routine use to treat symptoms of sore throat. This Cochrane review found that patients with severe or exudative sore. After 24 hours, corticosteroids had no effect on sore throat symptoms compared with the control group. Yet after 48 hours we did see a. Consider prescribing a single dose of corticosteroids for patients with sore throat; this has been found to provide quick pain relief and resolution of. Conclusion Single low dose corticosteroids can provide pain relief in patients with sore throat, with no increase in serious adverse effects. Readers' comments will be moderated - see our guidelines for further information. So along with researchers from the Universities of Oxford, Bristol and Southampton, we set out to shed some light on the issue by examining, for the first time, the effect of a single corticosteroid capsule given to patients in primary care who present with a sore throat. A single dose of corticosteroids is not likely to cause serious adverse effects moderate-quality evidence. In all eight RCTs, antibiotics were given to those in both the treatment and placebo groups.

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Click 'Find out more' for information on how to change your cookie settings. Gail Hayward. In the face of mounting pressure to reduce antibiotic prescribing, what alternatives are there for treating the one-in-ten people who visit their doctor each year with this common ailment?

As both a GP and an academic researcher, I see a lot of patients who are suffering with sore throats, and I know that effective alternative treatments to antibiotics would be welcomed by both GPs and patients. While previous research on the subject has suggested a role for corticosteroids, the evidence is yet to be compelling enough to herald a step-change in our approach to acute sore throat. So along with researchers from the Universities of Oxford, Bristol and Southampton, we set out to shed some light on the issue by examining, for the first time, the effect of a single corticosteroid capsule given to patients in primary care who present with a sore throat.

After 24 hours, corticosteroids had no effect on sore throat symptoms compared with the control group. This means that on average a doctor would need to prescribe corticosteroids to 12 patients to help 1 additional patient feel better after 48 hours. So is this effect at 48 hours strong enough evidence to warrant a shift to GPs prescribing corticosteroids routinely for sore throat? And then there are the side-effects of corticosteroids to consider — such as changes in mood and increased appetite in the short term, and weaker bones and high blood pressure after using steroids frequently for longer periods of time.

If patients were taking steroid courses for other medical conditions at the same time as visiting their doctor with a sore throat, these longer-term side effects might start to become a concern. We also need to consider whether patients might seek GP appointments more frequently for sore throat if their GP were to prescribe steroids, which could reduce the amount of time GPs have to spend with patients with more serious medical conditions. While corticosteroids may still play a role in other aspects of sore throat management due to their anti-inflammatory properties, such as for patients seen in hospital settings, or if a patient is unable to swallow or take other medications, GPs should continue to fall back on conventional wisdom for sore throat — over-the-counter painkillers, drinking plenty of fluids and time.

Is there a link between antibiotic use in gastrointestinal illness and complications such as arthritis and irritable bowel syndrome? DPhil student Seun Esan investigates. Readers' comments will be moderated - see our guidelines for further information. Hayward GN. Cookies on this website. Accept all cookies Reject all non-essential cookies Find out more. News and opinion Opinion: Research and teaching blog Can steroids soothe the thorny issue of acute sore throat? Can steroids soothe the thorny issue of acute sore throat?

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