Sore throat is a common reason for people to seek medical care, yet antibiotics have only a modest beneficial effect in reducing symptoms and fever. High rates of antibiotic prescriptions also lead to resistance and recent guidelines recommend that antibiotics should not be prescribed for sore throat.
So Dr Matthew Thompson at the University of Oxford and colleagues tested the theory that corticosteroids could effectively relieve symptoms of a sore throat due to their anti-inflammatory effects.
They analysed the results of eight trials comparing corticosteroids to placebo in adults or children. The trials involved a total of 743 patients (369 children and 374 adults) with symptoms of severe sore throat.
Differences in study design and quality were taken into account to minimise bias.
Patients given corticosteroids in addition to antibiotics were three times more likely to report complete resolution of pain at 24 hours than patients given placebo. This effect on pain was less apparent by 48 hours, suggesting that a single dose of corticosteroids may be sufficient, say the authors.
Corticosteroids also reduced the average time to pain relief by about six hours. However, the authors point out that significant effects were seen only in adult patients and only in those receiving oral corticosteroids. Use of simple painkillers made no difference in the trials where this was measured.
These findings suggest that, in patients with severe sore throat, pain can be reduced and resolution hastened by use of corticosteroids in conjunction with antibiotic therapy, say the authors. These results may also help to prevent antibiotic use, particularly in the context of delayed prescribing. Future research should focus on the effect of corticosteroids independent of antibiotics, they conclude.
An accompanying editorial warns that, although steroids reduce pain in the first day, data on harms are lacking.