Mounting Evidence for Dexamethasone in Pharyngitis

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In patients age 5 years through adulthood with sore throat of any cause, use of a single, low-dose steroid (most often dexamethasone 10mg or 0.6mg/kg for children, max 10mg; most given orally) were twice as likely to have complete pain relief at 24 hours.

Why does this matter?
Pharyngitis hurts.  Giving a dose of a corticosteroid reduces pain without increasing complications.  Especially in patients who are rapid strep negative, in whom antibiotic treatment in not warranted, it can feel like we have nothing to offer.  This gives us something to offer patients who have viral pharyngitis - treatment of their pain.  This can be a huge boost for patient satisfaction with little downside.

More evidence for dex
Steroid use is not completely benign.  And steroids don't help lower respiratory tract infection in patients without asthma.  A recent RCT on this topic in JAMA was met with mixed reviews.  But a Cochrane Review found steroids were helpful, NNT = 3.  This large meta-analysis of 10 RCTs found glucocorticoids were helpful in reducing pain, with patients twice as likely to have complete pain relief at 24 hours and 1.5 times as likely to have complete pain resolution at 48 hours.  Complete pain resolution was 11 hours sooner in the steroid group. Adverse events were not appreciably increased in patients who received steroids.

Source
Corticosteroids for treatment of sore throat: systematic review and meta-analysis of randomised trials.  BMJ. 2017 Sep 20;358:j3887. doi: 10.1136/bmj.j3887.

Peer reviewed by Thomas Davis, MD.

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