A Cochrane review [Abstract] 1 included 8 trials with a total of 743 participants (369 children and 374 adults). All trials gave antibiotics to both placebo and corticosteroid groups; no trials assessed corticosteroids as standalone treatment for sore throat. In addition to any effect of antibiotics and analgesia, corticosteroids increased the likelihood of complete resolution of pain at 24 hours by more than 3 times (RR 3.2, 95% CI 2.0 to 5.1, p < 0.001) and at 48 hours by 1.7 times. Fewer than 4 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 and the mean time to complete resolution of pain by 6 and 14 hours, respectively. At 24 hours, pain (assessed by visual analogue scores) was reduced by an additional 14% by corticosteroids. 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.
Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in outcomes).
A systematic review 2 including 22 studies with a total of 2817 subjects was abstracted in DARE. The efficacy of non-antibiotic interventions for sore throat ranged from no effect to 93%. Ibuprofen appeared to have immediate efficacy, reducing throat pain in adults by 32 to 80% relative to placebo after 2 to 4 hours, and by 70% at 6 hours (2 trials, n=109). Ibuprofen had lower efficacy in children: 25% after 2 hours (1 trial, n=78), although after 2 days there was a 56% reduction in children still with a sore throat (1 trial, n=153). Morniflumate suppositories (plus antibiotics) in children were no better than placebo at day 3, although there was a 34% reduction in pharyngeal pain after 4 days (1 trial, n=101). Better doctor-patient communication, in addition to prescribing antibiotics, improved symptoms by day 3. This was particularly the case in patients who had a positive culture for beta-haemolytic streptococci (1 trial, n=100 adults).
A topic in Clinical Evidence2 summarizes the results of 3 RCTs on paracetamol for sore throat. All RCTs found that paracetamol reduced sore throat pain compared with placebo (p<0.01). Two RCTs found that dexamethasone 10 mg reduced pain at 24 hours. The trials were too small to detect potential harms.
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