The quality of evidence is downgraded by imprecise results (few patients and outcome events).
Single dose of oral corticosteroid in conjunction with antibiotic therapy is suggested for adults with markedly painful sore throat requiring antibiotic therapy, if usual pain medication is insufficient.
A Cochrane review [Abstract] 1 included 9 studies with a total of 1319 subjects (369 children and 950 adults). In eight trials, participants in both corticosteroid and placebo groups received antibiotics; one trial offered delayed prescription of antibiotics based on clinical assessment.
In addition to any effect of antibiotics and analgesia, corticosteroids increased the likelihood of complete resolution of pain at 24 hours by 2.40 times (TableT1). Five people need to be treated to prevent one person continuing to experience pain at 24 hours. Corticosteroids also reduced the mean time to onset of pain relief by 6 hours and the mean time to complete resolution of pain by 11.6 hours. No difference in rates of recurrence, relapse or adverse events were reported for participants taking corticosteroids compared to placebo, although reporting of adverse events was poor. Courses shorter than one week are unlikely to be harmful 2.
| Outcome | Participants (studies) | Assumed risk - control | Corresponding risk (95% CI) -corticosteroids | Relative effect (95% CI) |
|---|---|---|---|---|
| Complete resolution of sore throat pain at 24 hours (patient report) | 851 (5) | 158 per 1000 | 379 per 1000 (204 to 706) | RR 2.40 (1.29 to 4.47) |
| Complete resolution of sore throat pain at 48 hours (patient report) | 774 (4) | 327 per 1000 | 491 per 1000 (416 to 576) | RR 1.50 (1.27 to 1.76) |
| Mean time to onset of pain relief in hours (patient report) | 840 (7) | The mean time to onset of pain relief was 17.7 hours | The mean time to onset of pain relief was 5.96 hours shorter (8.75 to 3.17) | |
| Mean time to complete resolution of sore throat pain (patient report) | 695 (6) | The mean time to complete resolution of pain was 50.4 hours | The mean time to complete resolution of pain in the intervention groups was 11.62 hours shorter (22.17 to 1.08 hours) | |
| Mean absolute reduction in sore throat pain at 24 hours | 1004 (7) | The mean absolute reduction in pain at 24 hours in the control groups was 3.7 VAS units (max 10, min 0) | The mean absolute reduction in pain at 24 hours in the intervention groups was 1.06 greater (0.21 to 1.92 greater) |
Given the limited benefit, further research into the harms and benefits of short courses of steroids is needed to permit informed decision-making.
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