Steroids as Adjuvant Therapy for Acute Pharyngitis in Ambulatory Patients: A Systematic Review

Korb, K; Scherer, Martin; Chenot, Jean‐François

doi:10.1370/afm.1038

Cited by 30 publications

(17 citation statements)

References 19 publications

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“…A 2008 systematic review of RCTs concerning the use of adjuvant corticosteroids in the treatment of acute pharyngitis was conducted. All eight RCTs included in the review reported statistically significant reductions in pain compared to placebo . Another systematic review of RCTs investigating the use of adjuvant corticosteroids after tonsillectomy also found statistically significant improvement in recovery with adjuvant steroids .…”

Section: Discussionsupporting

confidence: 69%

Adjunct steroids in the treatment of peritonsillar abscess: A systematic review

2017

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Section: Discussionsupporting

confidence: 69%

Adjunct steroids in the treatment of peritonsillar abscess: A systematic review

2017

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“…This has led some authors to suggest the universal use of corticosteroids in the treatment of AP, but systematic reviews or meta-analyses have shown that no definite conclusions can be drawn because some of the studies had methodological weaknesses in the way they assessed drug efficacy, and others did not adequately consider important characteristics of the enrolled patients or corticosteroid administration that may have influenced the results [8,[25][26][27]. Moreover, the advantage of corticosteroid use (i.e.…”

Section: Acute Pharyngitis (Ap)mentioning

confidence: 99%

No evidence for the effectiveness of systemic corticosteroids in acute pharyngitis, community-acquired pneumonia and acute otitis media

Principi

Bianchini

Baggi

et al. 2012

Eur J Clin Microbiol Infect Dis

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Corticosteroids have been used to treat infectious diseases for more than 50 years but, although it has been shown that they are highly effective in improving the clinical course of some diseases, their effects have not been clearly defined in others. Nevertheless, they are still used by a considerable number of physicians. This review analyses the role of systemic corticosteroids in the treatment of acute pharyngitis (AP), community-acquired pneumonia (CAP) and acute otitis media (AOM). A number of trials involving patients with AP have been carried out, but most are marred by methodological flaws that do not allow any firm conclusions to be drawn. The number of trials involving CAP patients is even higher, and the data suggest that corticosteroids may reduce the risk of death only in patients with severe disease. There are very few data concerning AOM, and there is currently no reason for prescribing corticosteroids to treat it. Overall, the data showed that there is, currently, no indication for the universal use of systemic corticosteroids in any of the reviewed diseases and, further, high-quality studies of all of these respiratory tract infections are needed in order to identify the patients for whom the prescription of corticosteroids is rationally acceptable.

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“…Randomised control trials doi: 10.1136/bmj.j3887 | BMJ 2017;358:j3887 | the bmj suggest that a short course of low-to-moderate dose corticosteroids probably provides symptomatic benefit to patients with sore throat. [11][12][13][14] Despite this evidence, clinicians do not commonly use steroids. Reasons might include uncertain applicability of the evidence to patients with less severe disease, as the initial studies enrolled only patients with severe sore throat presenting to emergency departments, almost all of whom received antibiotics.…”

Section: Introductionmentioning

confidence: 99%

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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Steroids as Adjuvant Therapy for Acute Pharyngitis in Ambulatory Patients: A Systematic Review

Cited by 30 publications

References 19 publications

Adjunct steroids in the treatment of peritonsillar abscess: A systematic review

Adjunct steroids in the treatment of peritonsillar abscess: A systematic review

No evidence for the effectiveness of systemic corticosteroids in acute pharyngitis, community-acquired pneumonia and acute otitis media

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

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