Effect of Oral Dexamethasone Without Immediate Antibiotics vs Placebo on Acute Sore Throat in Adults

Hayward, Gail; Moore, Michael; Jawad, Sena; Williams, Nicola; Voysey, Merryn; Cook, Johanna; Allen, Julie; Thompson, Matthew; Little, Paul; Perera, Rafael; Wolstenholme, Jane; Harman, Kim; Heneghan, Carl

doi:10.1001/jama.2017.3417

Cited by 34 publications

(46 citation statements)

References 27 publications

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“…Eight studies recruited patients from hospital emergency departments23 24 25 26 27 28 29 30 and two from primary care 1631 Three studies enrolled children,27 28 29 six studies enrolled adults,16 24 25 26 30 31 and one study included both children and adults 23. Oral dexamethasone (single dose of 10 mg for adults and 0.6 mg/kg, maximum 10 mg for children) was the most common intervention (five studies) followed by single dose intramuscular injection of dexamethasone (three studies).…”

Section: Resultsmentioning

confidence: 99%

“…All patients in three trials received both antibiotics and analgesics as the usual care25 26 30; in two trials, all patients received antibiotics, while analgesics were prescribed at the physician’s discretion 2324 In the five remaining trials, patients in usual care group received antibiotics or analgesics at the physician’s discretion 1627 28 29 31Table 1 presents study details.…”

Section: Resultsmentioning

confidence: 99%

“…In the five randomised controlled trials that reported complete resolution of symptoms at 24 hours,16 25 29 30 31 patients who received a single dose of corticosteroids were twice as likely to experience complete symptom resolution than placebo patients (relative risk 2.24, 95% confidence interval 1.17 to 4.29; I 2 =69%, 22.4% v 10.0%; moderate quality evidence; fig 2, table 2). All studies reporting this outcome were at low risk of bias.…”

Section: Resultsmentioning

confidence: 99%

“…In the four trials that reported complete resolution of pain at 48 hours,16 29 30 31 patients treated with corticosteroids were 50% more likely to experience complete resolution (relative risk 1.48, 95% confidence interval 1.26 to 1.75; I 2 =3%, 60.8% v 42.5%; high quality; fig 3, table 2). These four studies were all at low risk of bias, and tests of interaction showed no evidence of any subgroup effect (table A in appendix 3).…”

Section: Resultsmentioning

confidence: 99%

“…The aim of the project is to respond to new potentially practice changing evidence and provide a trustworthy practice guideline in a timely manner 15. In this case, the stimulus was the recent TOAST (Treatment Options without Antibiotics for Sore Throat) trial, which randomised over 500 patients with sore throat presenting to their primary care clinician who were not initially prescribed antibiotics; the TOAST authors reported beneficial effects of corticosteroids 16. In the light of this new potentially practice changing evidence, we updated the latest Cochrane review12 dealing with the effectiveness and safety of corticosteroids as an adjunct treatment for sore throat in addition to standard care compared with standard care alone.…”

Section: Introductionmentioning

confidence: 99%

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Corticosteroids for treatment of sore throat: systematic review and meta-analysis of randomised trials

Sadeghirad

Siemieniuk

Brignardello‐Petersen

et al. 2017

BMJ

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Objective To estimate the benefits and harms of using corticosteroids as an adjunct treatment for sore throat. Design Systematic review and meta-analysis of randomised control trials. Data sources Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), trial registries up to May 2017, reference lists of eligible trials, related reviews. Study selection Randomised controlled trials of the addition of corticosteroids to standard clinical care for patients aged 5 or older in emergency department and primary care settings with clinical signs of acute tonsillitis, pharyngitis, or the clinical syndrome of sore throat. Trials were included irrespective of language or publication status. Review methods Reviewers identified studies, extracted data, and assessed the quality of the evidence, independently and in duplicate. A parallel guideline committee (BMJ Rapid Recommendation) provided input on the design and interpretation of the systematic review, including the selection of outcomes important to patients. Random effects model was used for meta-analyses. Quality of evidence was assessed with the GRADE approach. Results 10 eligible trials enrolled 1426 individuals. Patients who received single low dose corticosteroids (the most common intervention was oral dexamethasone with a maximum dose of 10 mg) were twice as likely to experience pain relief after 24 hours (relative risk 2.2, 95% confidence interval 1.2 to 4.3; risk difference 12.4%; moderate quality evidence) and 1.5 times more likely to have no pain at 48 hours (1.5, 1.3 to 1.8; risk difference 18.3%; high quality). The mean time to onset of pain relief in patients treated with corticosteroids was 4.8 hours earlier (95% confidence interval −1.9 to −7.8; moderate quality) and the mean time to complete resolution of pain was 11.1 hours earlier (−0.4 to −21.8; low quality) than in those treated with placebo. The absolute pain reduction at 24 hours (visual analogue scale 0-10) was greater in patients treated with corticosteroids (mean difference 1.3, 95% confidence interval 0.7 to 1.9; moderate quality). Nine of the 10 trials sought information regarding adverse events. Six studies reported no adverse effects, and three studies reported few adverse events, which were mostly complications related to disease, with a similar incidence in both groups. Conclusion Single low dose corticosteroids can provide pain relief in patients with sore throat, with no increase in serious adverse effects. Included trials did not assess the potential risks of larger cumulative doses in patients with recurrent episodes of acute sore throat. Systematic review registration PROSPERO CRD42017067808.

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