Corticosteroids as standalone or add-on treatment for sore throat

Gail Hayward, Rafael Perera, Paul P. Glasziou, Chris B. Del Mar, Carl J. Heneghan

Research output: Contribution to journalArticleResearchpeer-review

38 Citations (Scopus)

Abstract

Background

Sore throat is a common condition associated with a high rate of antibiotic prescriptions, despite limited evidence for the effectiveness of antibiotics. Corticosteroids may improve symptoms of sore throat by reducing inflammation of the upper respiratory tract.

Objectives

To assess the clinical benefit and safety of corticosteroids for symptoms of sore throat in adults and children.

Search methods

We searched The Cochrane Library, the Cochrane Central Register of Controlled Trials (CENTRAL 2012, Issue 5) which includes the Acute Respiratory Infections (ARI) Group's Specialised Register, the Database of Reviews of Effects and the NHS Health Economics Database, MEDLINE (1966 to November Week 4, 2012) and EMBASE (1974 to June 2012).

Selection criteria

We included randomised controlled trials that compared steroids to either placebo or standard care in adults and children (older than three years of age) with sore throat. We excluded studies of hospitalised participants, those with infectious mononucleosis, sore throat following tonsillectomy or intubation, or peritonsillar abscess.

Data collection and analysis

Two review authors independently reviewed and selected trials from searches, assessed and rated study quality, and extracted relevant data.

Main results

We included eight trials involving 743 participants (369 children and 374 adults). All trials gave antibiotics to both placebo and corticosteroid groups; no trials assessed corticosteroids as standalone treatment for sore throat. In addition to any effect of antibiotics and analgesia, corticosteroids increased the likelihood of complete resolution of pain at 24 hours by more than three times (risk ratio (RR) 3.2, 95% confidence interval (CI) 2.0 to 5.1, P <0.001, I-2 statistic 44%) and at 48 hours by 1.7 times. 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 and the mean time to complete resolution of pain by 6 and 14 hours, respectively, although significant heterogeneity was present. At 24 hours, pain (assessed by visual analogue scores) was reduced by an additional 14% by corticosteroids. 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.

Authors' conclusions

Oral or intramuscular corticosteroids, in addition to antibiotics, increase the likelihood of both resolution and improvement of pain in participants with sore throat. Further trials assessing corticosteroids in the absence of antibiotics and in children are warranted.

Original languageEnglish
Article number008268
Number of pages43
JournalCochrane Database of Systematic Reviews
Volume2012
Issue number10
DOIs
Publication statusPublished - 2012

Fingerprint

Pharyngitis
Adrenal Cortex Hormones
Anti-Bacterial Agents
Pain
Therapeutics
Placebos
Peritonsillar Abscess
Databases
Recurrence
Infectious Mononucleosis
Tonsillectomy
Pharynx
Intubation
MEDLINE
Respiratory Tract Infections
Respiratory System
Analgesia
Libraries
Prescriptions
Randomized Controlled Trials

Cite this

@article{e335c270e3004c98a8c10db0bd552b1d,
title = "Corticosteroids as standalone or add-on treatment for sore throat",
abstract = "BackgroundSore throat is a common condition associated with a high rate of antibiotic prescriptions, despite limited evidence for the effectiveness of antibiotics. Corticosteroids may improve symptoms of sore throat by reducing inflammation of the upper respiratory tract.ObjectivesTo assess the clinical benefit and safety of corticosteroids for symptoms of sore throat in adults and children.Search methodsWe searched The Cochrane Library, the Cochrane Central Register of Controlled Trials (CENTRAL 2012, Issue 5) which includes the Acute Respiratory Infections (ARI) Group's Specialised Register, the Database of Reviews of Effects and the NHS Health Economics Database, MEDLINE (1966 to November Week 4, 2012) and EMBASE (1974 to June 2012).Selection criteriaWe included randomised controlled trials that compared steroids to either placebo or standard care in adults and children (older than three years of age) with sore throat. We excluded studies of hospitalised participants, those with infectious mononucleosis, sore throat following tonsillectomy or intubation, or peritonsillar abscess.Data collection and analysisTwo review authors independently reviewed and selected trials from searches, assessed and rated study quality, and extracted relevant data.Main resultsWe included eight trials involving 743 participants (369 children and 374 adults). All trials gave antibiotics to both placebo and corticosteroid groups; no trials assessed corticosteroids as standalone treatment for sore throat. In addition to any effect of antibiotics and analgesia, corticosteroids increased the likelihood of complete resolution of pain at 24 hours by more than three times (risk ratio (RR) 3.2, 95{\%} confidence interval (CI) 2.0 to 5.1, P <0.001, I-2 statistic 44{\%}) and at 48 hours by 1.7 times. 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 and the mean time to complete resolution of pain by 6 and 14 hours, respectively, although significant heterogeneity was present. At 24 hours, pain (assessed by visual analogue scores) was reduced by an additional 14{\%} by corticosteroids. 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.Authors' conclusionsOral or intramuscular corticosteroids, in addition to antibiotics, increase the likelihood of both resolution and improvement of pain in participants with sore throat. Further trials assessing corticosteroids in the absence of antibiotics and in children are warranted.",
author = "Gail Hayward and Rafael Perera and Glasziou, {Paul P.} and {Del Mar}, {Chris B.} and Heneghan, {Carl J.}",
year = "2012",
doi = "10.1002/14651858.CD008268.pub2",
language = "English",
volume = "2012",
journal = "Cochrane database of systematic reviews (Online)",
issn = "1469-493X",
publisher = "Wiley-Blackwell",
number = "10",

}

Corticosteroids as standalone or add-on treatment for sore throat. / Hayward, Gail; Perera, Rafael; Glasziou, Paul P.; Del Mar, Chris B.; Heneghan, Carl J.

In: Cochrane Database of Systematic Reviews, Vol. 2012, No. 10, 008268, 2012.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Corticosteroids as standalone or add-on treatment for sore throat

AU - Hayward, Gail

AU - Perera, Rafael

AU - Glasziou, Paul P.

AU - Del Mar, Chris B.

AU - Heneghan, Carl J.

PY - 2012

Y1 - 2012

N2 - BackgroundSore throat is a common condition associated with a high rate of antibiotic prescriptions, despite limited evidence for the effectiveness of antibiotics. Corticosteroids may improve symptoms of sore throat by reducing inflammation of the upper respiratory tract.ObjectivesTo assess the clinical benefit and safety of corticosteroids for symptoms of sore throat in adults and children.Search methodsWe searched The Cochrane Library, the Cochrane Central Register of Controlled Trials (CENTRAL 2012, Issue 5) which includes the Acute Respiratory Infections (ARI) Group's Specialised Register, the Database of Reviews of Effects and the NHS Health Economics Database, MEDLINE (1966 to November Week 4, 2012) and EMBASE (1974 to June 2012).Selection criteriaWe included randomised controlled trials that compared steroids to either placebo or standard care in adults and children (older than three years of age) with sore throat. We excluded studies of hospitalised participants, those with infectious mononucleosis, sore throat following tonsillectomy or intubation, or peritonsillar abscess.Data collection and analysisTwo review authors independently reviewed and selected trials from searches, assessed and rated study quality, and extracted relevant data.Main resultsWe included eight trials involving 743 participants (369 children and 374 adults). All trials gave antibiotics to both placebo and corticosteroid groups; no trials assessed corticosteroids as standalone treatment for sore throat. In addition to any effect of antibiotics and analgesia, corticosteroids increased the likelihood of complete resolution of pain at 24 hours by more than three times (risk ratio (RR) 3.2, 95% confidence interval (CI) 2.0 to 5.1, P <0.001, I-2 statistic 44%) and at 48 hours by 1.7 times. 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 and the mean time to complete resolution of pain by 6 and 14 hours, respectively, although significant heterogeneity was present. At 24 hours, pain (assessed by visual analogue scores) was reduced by an additional 14% by corticosteroids. 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.Authors' conclusionsOral or intramuscular corticosteroids, in addition to antibiotics, increase the likelihood of both resolution and improvement of pain in participants with sore throat. Further trials assessing corticosteroids in the absence of antibiotics and in children are warranted.

AB - BackgroundSore throat is a common condition associated with a high rate of antibiotic prescriptions, despite limited evidence for the effectiveness of antibiotics. Corticosteroids may improve symptoms of sore throat by reducing inflammation of the upper respiratory tract.ObjectivesTo assess the clinical benefit and safety of corticosteroids for symptoms of sore throat in adults and children.Search methodsWe searched The Cochrane Library, the Cochrane Central Register of Controlled Trials (CENTRAL 2012, Issue 5) which includes the Acute Respiratory Infections (ARI) Group's Specialised Register, the Database of Reviews of Effects and the NHS Health Economics Database, MEDLINE (1966 to November Week 4, 2012) and EMBASE (1974 to June 2012).Selection criteriaWe included randomised controlled trials that compared steroids to either placebo or standard care in adults and children (older than three years of age) with sore throat. We excluded studies of hospitalised participants, those with infectious mononucleosis, sore throat following tonsillectomy or intubation, or peritonsillar abscess.Data collection and analysisTwo review authors independently reviewed and selected trials from searches, assessed and rated study quality, and extracted relevant data.Main resultsWe included eight trials involving 743 participants (369 children and 374 adults). All trials gave antibiotics to both placebo and corticosteroid groups; no trials assessed corticosteroids as standalone treatment for sore throat. In addition to any effect of antibiotics and analgesia, corticosteroids increased the likelihood of complete resolution of pain at 24 hours by more than three times (risk ratio (RR) 3.2, 95% confidence interval (CI) 2.0 to 5.1, P <0.001, I-2 statistic 44%) and at 48 hours by 1.7 times. 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 and the mean time to complete resolution of pain by 6 and 14 hours, respectively, although significant heterogeneity was present. At 24 hours, pain (assessed by visual analogue scores) was reduced by an additional 14% by corticosteroids. 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.Authors' conclusionsOral or intramuscular corticosteroids, in addition to antibiotics, increase the likelihood of both resolution and improvement of pain in participants with sore throat. Further trials assessing corticosteroids in the absence of antibiotics and in children are warranted.

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DO - 10.1002/14651858.CD008268.pub2

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VL - 2012

JO - Cochrane database of systematic reviews (Online)

JF - Cochrane database of systematic reviews (Online)

SN - 1469-493X

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