Steroids May Effectively Relieve Pain of Acute Pharyngitis
By Laurie Barclay, MD
Medscape Medical News
January 15, 2010 — Steroids are effective as adjuvant therapy in relieving pain in acute pharyngitis, according to the results of a systematic review reported in the January/February issue of the Annals of Family Medicine.
"A major treatment goal for patients complaining of sore throat is to relieve pain and alleviate difficulties in swallowing," write Katrin Korb, MD, from the University of Goettingen in Germany, and colleagues. "The anti-inflammatory action of steroids might be effective to relieve symptoms caused by inflammation and has been studied in other upper respiratory tract infections. Steroids might, therefore, represent a useful clinical option to meet patients' needs."
The purpose of this review was to summarize evidence from randomized controlled trials (RCTs) that assessed the efficacy of adjuvant therapy with corticosteroids to relieve the pain of acute pharyngitis. After searching MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews for RCTs published between 1966 and December 2008, 2 reviewers evaluated the quality of each identified article and summarized the data.
Of 8 identified RCTs enrolling a total of 806 ambulatory patients, 5 enrolled adult patients and 3 enrolled children. Compared with placebo, steroid use (dexamethasone, betamethasone, or prednisone) was associated with statistically significant faster reduction of pain or complete pain relief in all identified RCTs. Most participants had been treated with antibiotics at least initially. Although use of acetaminophen or other analgesic medication was permitted in all studies, this factor was not always controlled. There were no serious adverse effects.
"Steroids are effective in relieving pain in acute pharyngitis," the study authors write. "Although no serious adverse effects were observed, the benefits have to be balanced with possible adverse drug effects. There are safe and effective over-the-counter medications to relieve throat pain."
Limitations of this systematic review include possible publication bias favoring studies finding steroids to be beneficial, possible recall bias, and limitations inherent in the included studies. Specific drugs used, dosing and administration, and outcome measures all varied among the included trials.
"Most patients received concomitant antibiotics; however, reducing the prescription of antibiotics for generally benign upper respiratory tract infection is a public health goal," the review authors conclude. "We therefore recommend further studies to establish both the safety of steroids without antibiotic coverage and the additional benefits of steroids when used with regular administration of over-the-counter analgesic medications."
