The quality of evidence is downgraded by imprecise results (few patients and outcome events).
Single dose of oral corticosteroid in conjunction with antibiotic therapy is suggested for adults with markedly painful sore throat requiring antibiotic therapy, if usual pain medication is insufficient.A Cochrane review included 8 studies with a total of 743 subjects (369 children and 374 adults); 348 (47%) had exudative sore throat, 330 (44%) were group A beta-haemolytic streptococcus (GABHS) positive. Studies of hospitalised participants and studies of participants with infectious mononucleosis, sore throat following tonsillectomy or intubation, or peritonsillar abscess were excluded. In all included trials antibiotics were administered to both corticosteroid and placebo groups. Corticosteroids used included betamethasone 2 ml (estimated dose 8 mg), dexamethasone (up to 10 mg) or prednisone 60 mg administered either intramuscularly, orally or both. Six studies used a single dose of corticosteroids and 2 studies prescribed more than one dose of corticosteroids to a subgroup of participants.
In addition to any effect of antibiotics and analgesia, corticosteroids increased the likelihood of complete resolution of pain at 24 hours and at 48 hours (Table). Fewer than four people need to be treated to prevent one person continuing to experience pain at 24 hours. Corticosteroids also reduced the mean time to onset of pain relief by 6 hours and the mean time to complete resolution of pain by 14 hours, although significant heterogeneity was present, particularly in patients with bacterial pathogen negative sore throat. At 24 hours, subjective rating of pain (assessed by VAS, visual analogue scores) was reduced by 14% by corticosteroids, again associated with high heterogeneity. No difference in rates of recurrence, relapse or adverse events were reported for participants taking corticosteroids compared to placebo, although reporting of adverse events was poor. Courses shorter than one week are unlikely to be harmful .
| Outcome | Participants (studies) | Assumed risk - control | Corresponding risk (95% CI) -corticosteroids | Relative effect (95% CI) |
|---|---|---|---|---|
| Complete resolution of sore throat pain at 24 hours (patient report) | 286 (4) | 12 per 100 | 39 per 100 (24 to 62) | RR 3.16 (1.97 to 5.08) |
| Complete resolution of sore throat pain at 48 hours (patient report) | 209 (3) | 47 per 100 | 77 per 100 (62 to 97) | RR 1.65 (1.32 to 2.06) |
| Mean time to onset of pain relief in hours (patient report) | 609 (6) | The mean time to onset of pain relief was 14 hours | The mean time to onset of pain relief was 6.3 hours shorter (9.3 to 3.4) | |
| Mean time to complete resolution of sore throat pain (patient report) | 500 (5) | The mean time to complete resolution of pain was 46 hours | The mean time to complete resolution of pain in the intervention groups was 14 hours shorter (25 to 4 hours) | |
| Mean absolute reduction in sore throat pain at 24 hours | 617 (6) | The mean absolute reduction in pain at 24 hours in the control groups was 3.6 VAS units (max 10, min 0) | The mean absolute reduction in pain at 24 hours in the intervention groups was 1.3 greater (0.61 to 2.06 greater) |
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