This article is more than 5 years old. Information may no longer be current.

Corticosteroids provide pain relief for sore throat with little risk of adverse events

Single low dose corticosteroids reduced the intensity and duration of pain in patients with sore throat without increasing their risk for serious adverse events, according to findings published in BMJ.

“Sore throat is among the most common presenting complaints in both emergency departments and outpatient care settings. ... The most common cause of sore throat is acute pharyngitis caused by self limiting viral infections. Pain management with paracetamol (acetaminophen) or nonsteroidal anti-inflammatory drugs therefore represents the mainstay of care. These drugs provide limited pain relief but also sometimes cause serious harm,” Behnam Sadeghirad, PharmD, MPH, from McMaster University in Hamilton, Canada, and colleagues wrote.

Sadeghirad and colleagues sought to determine the benefits and harms of corticosteroids for sore throat. The researchers performed a systematic review and meta-analysis of 10 eligible randomized controlled trials that evaluated the treatment of corticosteroids in addition to standard care for a total of 1,426 patients aged 5 years or older who visited the ED or a primary care setting showing clinical signs of acute tonsillitis, pharyngitis or sore throat.

Data from the trials demonstrated that the occurrence of pain relief after 24 hours was doubled in patients treated with single low dose corticosteroids (RR = 2.2; 95% CI, 1.2-4.3; risk difference, 12.4%), with the most common corticosteroid being oral dexamethasone with a maximum dose of 10 mg. These patients were also more likely to have no pain at 48 hours (RR = 1.5; 95% CI, 1.3-1.8; risk difference, 18.3%).

Compared with patients who received placebo, those who received corticosteroids experienced pain relief at a mean of 4.8 hours earlier (95% CI, –1.9 to –7.8) and complete pain resolution at a mean of 11.1 hours earlier (95% CI, –0.4 to –21.8). Furthermore, in patients receiving corticosteroids, there was greater absolute pain reduction at 24 hours compared with those receiving placebo (mean difference, 1.3; 95% CI, 0.7-1.9).

Nine of the 10 trials reported the incidence of adverse events, with six reporting no adverse effects of corticosteroids and three reporting few adverse events — most of which were complications related to disease — in both groups.

“Although the benefits are relatively small, many patients are likely to consider them important,” Sadeghirad and colleagues concluded. “Patients with less severe sore throat, however, will obtain less absolute benefit from corticosteroids. Thus, the balance of benefits and harms almost certainly depends on the severity of the patient’s sore throat. With available evidence suggesting that serious adverse effects are rare or absent, the addition of one or two doses of steroids to the symptomatic management of sore throat is likely to appeal to many patients. More high quality data would be helpful to fully understand the net balance of benefits and harms according to severity of symptoms, particularly in primary care settings.” – by Alaina Tedesco

Disclosures: The authors report no relevant financial disclosures.