Low Dose Steroids useful in sore throat: Meta-analysis

In a systematic review and meta-analysis of randomised trials Behnam Sadeghirad et al. have found that single low dose corticosteroids can provide pain relief in patients with sore throat, with no increase in serious adverse effects.

Sore throat is among the most common presenting complaints in both emergency departments and outpatient care settings. It is the cause of about 5% of medical visits in children and about 2% of all outpatient visits in adults. The most common cause of sore throat is acute pharyngitis caused by self limiting viral infections. Pain management with paracetamol or non-steroidal anti-inflammatory drugs therefore represents the mainstay of care. These drugs provide limited pain relief but also sometimes cause serious harm.

Treatment of sore throat with antibiotics also provides modest benefit in reduction of symptoms and fever when the infection is bacterial, but their use could contribute to antibiotic resistance. Although most cases of sore throat have a viral aetiology, and the risk of secondary complications is low, clinicians commonly prescribe antibiotics.

In the present meta analysis which was conducted to estimate the benefits and harms of using corticosteroids as an adjunct treatment for sore throat a systematic review and meta-analysis of randomised control trials was done.The data sources were Medline, Embase, Cochrane Central Register of Controlled Trials , trial registries up to May 2017, reference lists of eligible trials and related reviews.

In the randomised controlled trials of the addition of corticosteroids to standard clinical care for patients aged 5 or older in emergency department and primary care settings with clinical signs of acute tonsillitis, pharyngitis, or the clinical syndrome of sore throat.

The reviewers identified studies, extracted data, and assessed the quality of the evidence, independently and in duplicate. A parallel guideline committee (BMJ Rapid Recommendation) provided input on the design and interpretation of the systematic review, including the selection of outcomes important to patients. Random effects model was used for meta-analyses. Quality of evidence was assessed with the GRADE approach.

In total 10 eligible trials 1426 individuals were enrolled. Patients who received single low dose corticosteroids (the most common intervention was oral dexamethasone with a maximum dose of 10 mg) were twice as likely to experience pain relief after 24 hours (relative risk 2.2, 95% confidence interval 1.2 to 4.3; risk difference 12.4%; moderate quality evidence) and 1.5 times more likely to have no pain at 48 hours (1.5, 1.3 to 1.8; risk difference 18.3%; high quality). The mean time to onset of pain relief in patients treated with corticosteroids was 4.8 hours earlier (95% confidence interval −1.9 to −7.8; moderate quality) and the mean time to complete resolution of pain was 11.1 hours earlier (−0.4 to −21.8; low quality) than in those treated with placebo. The absolute pain reduction at 24 hours (visual analogue scale 0-10) was greater in patients treated with corticosteroids (mean difference 1.3, 95% confidence interval 0.7 to 1.9; moderate quality). Nine of the 10 trials sought information regarding adverse events. Six studies reported no adverse effects, and three studies reported few adverse events, which were mostly complications related to disease, with a similar incidence in both groups.

The researchers concluded that single low dose corticosteroids can provide pain relief in patients with sore throat, with no increase in serious adverse effects. Included trials did not assess the potential risks of larger cumulative doses in patients with recurrent episodes of acute sore throat.

For further reading log on to : BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3887