This systematic review and meta-analysis included 10 RCTs with a sample of 1,426 patients, including adults and children aged 5 years or older, in ED and primary care settings who presented with signs of tonsillitis, pharyngitis, or the clinical syndrome of sore throat [throat pain and the pain with swallowing]. It essentially evaluated the efficacy of corticosteroids as an adjunct for treatment of sore throat, such as when used in combination with other analgesics [i.e. acetaminophen or NSAIDs]. A single dose of 10 mg of oral dexamethasone was the most common intervention followed by the same dose as an IM injection.
The outcomes of interest included complete resolution of pain at 24 and 48 hours; mean time to onset of pain relief; mean time to complete resolution of pain; absolute reduction of pain at 24 hours; duration of non-tolerable symptoms [problems eating, drinking, or swallowing]; recurrence/relapse of symptoms; days missed from school or work; need for antibiotics; and rate of adverse events related to treatment.
Ultimately, the study found that patients who received single low dose corticosteroids were two times as likely to experience pain relief after 24 hours and one and a half times more likely to have no pain at 48 hours. Compared to patients treated with placebo, the mean time to onset of pain relief in patients treated with the steroid was 4.8 hours earlier, and the mean time to complete resolution of pain was approximately 11 hours earlier. Additionally, little to no adverse effects were reported. However, findings were inconclusive regarding whether corticosteroids reduce recurrence/relapse of symptoms, number of days missed from school or work, duration of intolerable symptoms, or need for antibiotic use.
Nevertheless, the study demonstrates that single low dose steroids can provide pain relief in patients with sore throat by reducing the intensity and duration of pain without an increase in serious adverse effects. Though, it is important to consider the severity of sore throat, as patients with less severe sore throat would likely obtain less absolute benefit from taking a steroid. Moreover, though no serious adverse effects were reported, further studies are necessary to assess the potential risks of larger cumulative doses in patients with recurrent episodes of acute sore throat, such as if steroid treatments were prescribed routinely for each episode.
