Steroids for Sore Throat – The Evidence

November 18, 2020

Written by Sam Parnell

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Corticosteroids are associated with significant pain relief for sore throat with a NNT of 5 for complete resolution of pain at 24 and 48 hours.

Why does this matter?
Sore throat is a common reason for acute care presentation in the US. The vast majority of patients with sore throat do not require antibiotics, and the disease is usually self-limited. However, pain control is a significant issue and can even affect hydration and nutritional status in severe cases. Could the analgesic and anti-inflammatory properties of steroids be a cure-all for the patient with uncomplicated sore throat?

Corticosteroids: A Sweet Solution for Sore Throat!
This was a systematic review and meta-analysis of 9 double-blind, placebo-controlled, randomized trials investigating corticosteroids vs placebo for 1,319 patients with sore throat. Patients who were hospitalized, had peritonsillar abscess, or had sore throat after tonsillectomy or intubation were excluded.

Corticosteroids were associated with some convincing benefits including:

• 21% absolute reduction in pain at 24 hours

• 24% absolute reduction in pain at 48 hours

• 6 hour mean improvement in onset of pain relief

• 12 hour mean improvement in complete pain resolution

The number needed to treat (NNT) for complete resolution of pain at 24 and 48 hours was 5, and no significant harms (hospitalization, abscess, pneumonia, severe tonsillitis, or death) were reported.

Unfortunately, as detailed below, there were several limitations with this review.

• Most patients included in the trials also received antibiotics.

• The type, route, and duration of corticosteroids varied significantly (dexamethasone vs prednisone vs betamethasone, PO vs IM, given for 1, 2, or 3 days).

• Only 2 studies included pediatric patients.

• Only 2 studies reported adverse events.

So, the jury is still out as to whether steroids are actually a safe panacea for sore throat. However, based on the available evidence, steroids appear to result in quicker resolution of pain for uncomplicated sore throat. A single dose of steroids is likely the safest option, so I will continue my personal practice of administering a single dose of dexamethasone for patients with sore throat.

Source
Corticosteroids for sore throat. Acad Emerg Med. 2020 Sep 28. doi: 10.1111/acem.14143. Online ahead of print.

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