Corticosteroids as standalone or add-on treatment for sore throat

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Plain language summary

Review question

Are corticosteroids beneficial for people with sore throat either alone or in addition to other treatment?

Background

Sore throat is very common. Although most sore throats are caused by viruses, many people with sore throat receive antibiotics, which are not effective in treating viral infections. Overuse of antibiotics contributes to antibiotic resistance in individuals and the community. Sore throats are painful because of inflammation of the lining of the throat. Steroids, or corticosteroids, are medications that can be taken as tablets or injected. They reduce inflammation and help in other airways infections such as croup. Short courses of steroids may be beneficial to treat sore throat.

Search date

14 May 2019.

Study characteristics

This is an update of our 2012 review. We added one new trial (565 participants) for a total nine trials involving 1319 participants (369 children, 950 adults). The included trials were conducted in emergency department (7 trials) and primary care (2 trials) settings in the USA (5 trials), and one trial each in Canada, Israel, Turkey, and the UK. Participants received either a single dose of steroids or a single dose of a dummy drug (placebo) (7 trials). More than one consecutive daily dose of steroid or placebo was given to one group of participants, whilst the other group received a single dose (2 trials). In eight trials all participants also received antibiotics immediately on entry to the study. All trials were published in English.

Study funding sources

Two studies described funding sources (government and a university foundation).

Key results

Participants who received corticosteroids were 2.4 times more likely to experience complete resolution of sore throat symptoms by 24 hours than those who received placebo. Corticosteroids improved times to both start symptom relief and to completely resolve symptoms, although trial evidence was not consistent for these outcomes, and effects were modest. Adverse events, recurrence/relapse rates, and days missed from work or school did not differ between corticosteroid and placebo group participants. Sore throats are very common in children, but only two trials reported results for children, and these results were inconsistent, making it difficult to draw conclusions. Further research is therefore needed to examine the benefits of corticosteroids for both reducing antibiotic use in people with severe sore throat, and the benefit for children specifically. Limitations were that only two trials included children and that most trials also gave antibiotics to all participants.

Quality of the evidence

We assessed the certainty of the evidence as high for complete resolution of pain at 24 and 48 hours, and moderate for mean time to onset of pain relief, mean time to complete resolution of pain, absolute reduction in pain measured by visual analogue scales, adverse events, recurrence/relapse rates, and days missed from work or school.