Steroid Can Ease Severe Sore Throat

FRIDAY Aug. 7, 2009 -- A single dose of a corticosteroid, given along with antibiotics, can relieve severe sore throat pain faster and more effectively than antibiotics alone, a new study suggests.

"In people with severe sore throat, a single dose of an oral steroid is effective in relieving pain in 24 and 48 hours," said researcher Dr. Carl Heneghan, the deputy director of the Centre for Evidence-Based Medicine at the University of Oxford in the U.K.

This treatment is not advised for a mild sore throat, which will go away by itself, Heneghan stressed.

"If you turn up at your emergency department and you have really bad tonsillitis and you are in a lot of pain, an additional treatment is to take a single dose of a corticosteroid," he explained.

The report is published in the Aug. 7 online edition of BMJ.

Corticosteroids relieve pain by reducing inflammation and are commonly prescribed for conditions such as asthma and croup. Their use as a pain reliever for sore throat could help reduce the need for antibiotics, which can be overused and help create resistant bacteria, the U.K. researchers say.

For the study, Heneghan's group analyzed eight trials comparing the effectiveness of corticosteroids to placebo in adults or children with severe sore throats. In total, the studies included 743 patients, 369 of whom were children.

The researchers found that patients given corticosteroids plus antibiotics were three times more likely to report having no pain 24 hours after treatment compared with patients given antibiotics and a placebo.

After two days this effect was less apparent, which suggests that a single dose of corticosteroids is all that is needed, according to the researchers. In addition, corticosteroids also reduced the time it took to relieve pain by about six hours.

Heneghan's team noted that significant pain relief was only observed in adult patients and not in children receiving corticosteroids.

In addition, other painkillers made no difference in the results, the researchers found.

"What we don't know is: do corticosteroids replace antibiotics?" Heneghan stated. "That's another piece of research we would like to do," he said.

Dr. Julie Wei, an assistant professor of otolaryngology at the University of Kansas Medical Center, agreed that steroids work well in relieving severe sore throat pain, but she cautioned that they are not a substitute for antibiotics, which treat the infection, not the pain.

"The use of steroid should never be for the purpose of replacing antibiotics," Wei said. "Based on the current information, that is not the conclusion people should have."

Single-dose steroid use is already a common practice, Wei said. "For example, all my pediatric patients undergoing tonsillectomy and adenoidectomy get a single dose intravenously at the time of surgery, because steroids are the most potent anti-nausea, anti-vomiting medication we have," she said.

Single-dose steroids also help improve eating and drinking, and feeling good, Wei said. "Also, people in the emergency room or children admitted for throat abscess usually get a single dose of steroids if they are having severe pain or difficulty opening their mouth due to inflammation. We ENTs already recommend that commonly," she added.

"The bottom line is, it is already commonly used in anesthesia, ER setting, etc., but does not replace antibiotics," Wei said.

More information

For more information on sore throat, visit the U.S. National Library of Medicine.

Posted: August 2009


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