Corticosteroids have an immunosuppressant effect and carry the theoretical risk for exacerbation of an existing infection. That did not occur in these studies. Nor has it occurred when short courses of corticosteroids are used for other illnesses, such as croup, infectious mononucleosis, asthma, contact dermatitis, and COPD.14 Thus, this theoretical risk is not a barrier to implementation.
It is important to note that single and multiple doses of corticosteroids and oral and IM routes were effective, with only minimal differences in results.
CHALLENGES TO
IMPLEMENTATION
Determining the severity
Acetaminophen and NSAIDs are used for pain relief in sore throat and have been shown to be effective—but may be inadequate for severe pain.15 There are no head-to-head trials that have compared steroids to NSAIDs or acetaminophen in this clinical scenario. So the challenge for clinicians will be to decide when pharyngitis is severe enough to justify the use of corticosteroids, rather than simple analgesics alone.
REFERENCES
1. Hayward G, Thompson M, Perera R, et al. Corticosteroids as stand-alone or add-on treatment for sore throat. Cochrane Database Syst Rev. 2012;(10):CDC008268.
2. Cherry DK, Woodwell DA. National Ambulatory Medical Care Survey: 2000 summary. Adv Data. 2002;328:1-32.
3. Bisno AL. Acute pharyngitis. N Engl J Med. 2001;344:205-211.
4. Del Mar CB, Glasziou PP, Sprinks AB. Antibiotics for sore throat. Cochrane Database Syst Rev. 2006;(4):CD000023.
5. Linder JA, Stafford RS. Antibiotic treatment of adults with sore throat by community primary care physicians: a national survey, 1989-1999. JAMA. 2001;286:1181-1186.
6. Linder JA, Bates DW, Lee GM, et al. Antibiotic treatment of children with sore throat. JAMA. 2005;294:2315-2322.
7. Hong SY, Taur Y, Jordan MR. Antimicrobial prescribing in the USA for adult acute pharyngitis in relation to treatment guidelines. J Eval Clin Pract. 2011;17:1176-1183.
8. van Driel ML, De Sutter A, Deveugele M, et al Are sore throat patients who hope for antibiotics actually asking for pain relief? Ann Fam Med. 2006;4:494-499.
9. Venekamp RP, Thompson MJ, Hayward G, et al. Systemic corticosteroids for acute sinusitis. Cochrane Database Syst Rev. 2011;(12): CD008115.
10. Russell KF, Liang Y, O’Gorman K, et al. Glucocorticoids for croup. Cochrane Database Syst Rev. 2011;(1):CD001955.
11. Rowe BH, Spooner C, Ducharme F, et al. Early emergency department treatment of acute asthma with systemic corticosteroids. Cochrane Database Syst Rev. 2001;(1):CD002178.
12. Korb K, Scherer M, Cenot J. Steroids as adjuvant therapy for acute pharyngitis in ambulatory patients: a systematic review. Ann Fam Med. 2010;8:58-63.
13. Olympia RP, Khine H, Avner JR. Effectiveness of oral dexamethasone in the treatment of moderate to severe pharyngitis in children. Arch Pediatr Adolesc Med. 2005;159:278-282.
14. Manson SC, Brown RE, Cerulli A, et al. The cumulative burden of oral corticosteroid side effects and the economic implications of steroid use. Respir Med. 2009;103:975-994.
15. Wei JL, Kasperbauer JL, Weaver AL, et al. Efficacy of single-dose dexamethasone as adjuvant therapy for acute pharyngitis. Laryngoscope. 2002;112:87-93.
Acknowledgement
The PURLs Surveillance System was supported in part by Grant Number UL1RR024999 from the National Center for Research Resources, a Clinical Translational Science Award to the University of Chicago. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources or the National Institutes of Health.
Copyright © 2013. The Family Physicians Inquiries Network. All rights reserved.
Reprinted with permission from the Family Physicians Inquiries Network and The Journal of Family Practice. 2013;62(7):372-374.