Adults with acute sore throat are too often prescribed antibiotics, despite the lack of evidence that antibiotics relieve symptoms effectively and guidelines that advise against their use for this condition. A new study published in the Journal of the American Medical Association finds that a single dose of oral dexamethasone alone may be sufficient to resolve symptoms 2 days after presentation.
Looking for a way to reduce inappropriate antibiotic use for acute sore throats but still reduce associated symptoms, British researchers conducted a double-blind, placebo-controlled randomized trial to evaluate whether a single dose of oral corticosteriod could be an effective treatment alternative.
Over 2 years, 576 adult patients (median age 34) from 42 health clinics in England who had sore throats with pain on swallowing were randomly assigned to receive either a single 10-mg oral dose of dexamethasone or placebo (lactose). The patients were either not prescribed an antibiotic or were prescribed an antibiotic to be taken only if they had persistent symptoms after 48 hours.
Symptoms were reevaluated over the next 7 days by text or telephone. Patients whose sore throats were so severe that clinicians deemed they needed immediate antibiotics were not included in the study. Although streptococcal tests were done, clinicians did not have the results at the time of medication prescribing.
At 24 hours after intervention, there was no significant difference in symptom resolution between patients who got dexamethasone and those who got the placebo. At 48 hours, however, 35.4% in the dexamethosone group vs 27.7% in the placebo group reported complete resolution of their symptoms.
The researchers noted that although the patients did use over-the-counter analgesic-containing topical and oral medications, their use was similar for both groups. They also noted that neither sore throat severity nor presence of strep throat affected the study results.
It was speculated that because corticosteriods are most effective for severe sore throat, there might have been a greater difference between the dexamethasone group and the placebo group if patients with the most severe symptoms had not been excluded from the trial.
The researchers point out that more research needs to be done, including on children, and that the adverse effects of corticosteroids need to be considered—particularly in patients with other medical conditions such as diabetes and heart failure or in patients who might potentially get culmulative larger doses of corticosteroids from multiple primary care visits.
With those cautions noted, this study shows that corticosteroids might be an alternative therapy to consider for acute sore throat, which may help reduce prescribing of antibiotics.
Hayward GN, Hay AD, Moore MV, et al. Efffect of oral dexamethasone without immediate antibiotics vs placebo on acute sore throats in adults: a randomized clinical trial. JAMA. 2017;317:1535-1543.