Corticosteroids hasten resolution of sore throat symptoms in adults

Clinical question Do systemic corticosteroids reduce symptoms in adults and children with sore throat?

Bottom line When added to treatment with antibiotics and analgesia, a single dose of a corticosteroid triples the likelihood that adults would be completely pain free within 24 hours, with one additional patient being pain free for every four patients treated. None of the studies show a benefit of corticosteroid treatment in children. (Level of evidence = 1a)

Synopsis More than 100 years ago, Jane Austen described a sentiment similarly held by many people today: “No one's sore throats, you know, are as bad as mine.” These authors combined the results of eight randomized trials enrolling a total of 369 children and 374 adults with sore throat (44% were positive for group A beta-hemolytic streptococcus). Several studies enrolled patients with severe symptoms. They identified the studies by searching six databases. Two authors independently performed the searches and then extracted the data. The quality of the research was high. When added to antibiotics and analgesia in four trials, an oral corticosteroid increased the likelihood of adults being pain free within 24 hours, with one additional patient being pain free for every four patients treated with a corticosteroid (number needed to treat [NNT] = 3.7; 95% CI, 2.8-5.9). Similarly, in three studies the treatment increased the likelihood of complete resolution within 48 hours in adults (NNT = 3.3; 2.4-5.6). The studies used single oral or IM doses of 60 mg prednisone or 10 mg dexamethasone equivalents. Treatment was not shown to be beneficial in children.

Hayward G, Thompson M, Heneghan C, et al. Corticosteroids for pain relief in sore throat: systematic review and meta-analysis. BMJ. 2009;339:b2976. doi:10.1136/bmj.b2976.