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Steroids Might Relieve Sore Throat Pain

A meta-analysis shows that a single dose of steroids, given in addition to standard antibiotics, hastens resolution of pain in adults with exudative pharyngitis or bacterial pharyngitis.

Pain from sore throat is a principal symptom for which patients with pharyngitis seek medical attention. Steroids inhibit inflammation and therefore might relieve symptoms of pharyngitis. Researchers performed a meta-analysis of eight randomized placebo-controlled trials that evaluated steroid treatment in 743 outpatients (369 children and 374 adults) with sore throats. Steroids were administered orally in four trials (dexamethasone 0.6 mg/kg or 10 mg, prednisone 60 mg for 1 or 2 days), intramuscularly in three (dexamethasone 8 or 10 mg, betamethasone 8 mg), and by both routes in one. All patients received antibiotics.

Overall, 47% of patients had exudative pharyngitis, and 44% tested positive for group A β-hemolytic streptococcus. Patients who received steroids were significantly more likely than placebo recipients to report pain resolution at 24 hours (relative risk, 3.2) and at 48 hours (RR, 1.7). Pain relief occurred an average of 6.3 hours faster in the steroid groups. Results were more pronounced in patients with exudative pharyngitis and in those with bacterial etiologies. No benefit from steroids was observed in children. None of the trials reported increases in adverse events in the steroid groups.

Comment: Although the route of administration and the type of steroid were not standardized, the results of this meta-analysis support administration of a single dose of oral steroids in the emergency department as a reasonable option in adult patients with pharyngitis who have severe pain and exudative pharyngitis or positive bacteriological testing.

— Kristi L. Koenig, MD, FACEP

Published in Journal Watch Emergency Medicine August 28, 2009

Citation(s):

Hayward G et al. Corticosteroids for pain relief in sore throat: Systematic review and meta-analysis. BMJ 2009 Aug 6; 339:b2976. (http://dx.doi.org/10.1136/bmj.b2976)

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• Medline abstract (Free)

Little P. Sore throat in primary care. BMJ 2009 Aug 6; 339:b2476. (http://dx.doi.org/10.1136/bmj.b2476)

• Original article (Subscription may be required)
• Medline abstract (Free)

Reader Remarks:

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• Steroid for relief of sore throat
  Benjamin D. Gordon, M.D., 1 Sep 2009 9:05 PM EST
  The first line of defense against infection is the inflammatory response. Why give an anti-inflammatory when the old-fashioned teatment of... [more]
• steroids in exudative pharyngitis for pain relief
  Diane Miessler, ED, 2 Jan 2010 11:08 AM EST
  This begs the question: would INHALED steroids also work? And as Dr. Gordon asks, above, what about undermining the inflammatory... [more]
• Why to feel pain?
  Rafael Mialski, Universidade Federal do Paraná - Brazil, 9 Jan 2010 9:57 AM EST
  I agree with Dr. Gordon, that inflammatory response is our first line defense. But, if it brings pain, we should... [more]