Dexamethasone vs placebo for acute sore throat in adults

1. This double-blinded, placebo-control trial found that, among patients with acute sore throat, those who received dexamethasone were no more likely than those who received placebo to have complete symptom resolution at 24 hours.

2. At 48 hours, more participants receiving dexamethasone had symptom resolution compared to those who received placebo.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Acute sore throat is a common presenting symptom for patients seeking urgent care. Antibiotics are prescribed during a majority of visits (60% of primary care consultations in UK), despite limited symptomatic benefit and national guidelines advising against their use. Corticosteroids have been shown to be effective in upper respiratory tract infections such as acute sinusitis and croup. However, the effectiveness of corticosteroids without antibiotics for sore throat in primary care has not yet been established. This double-blinded, randomized, placebo-controlled study found patients who received dexamethasone were not more likely than placebo to have complete symptom resolution at 24 hours. However, at 48 hours, more patients who received dexamethasone had complete symptom resolution compared to placebo.

This study was the first to describe effect of oral corticosteroids for acute sore throat in a primary care setting. Some limitations include selection bias, as the study recruited patients with milder symptoms of sore throat and excluded those deemed to require immediate antibiotics. Children were likewise excluded. Furthermore, this study was underpowered, and a larger study needs to be done to validate a statistically significant difference between treatments in acute sore throat symptom resolution. Overall, this study provides data that dexamethasone does not significantly improve acute sore throat symptoms compared to placebo, 24 hours post-presentation.

Click to read the study, published in JAMA

Relevant Reading: Prescribing of Antibiotics for Self-Limiting Respiratory Tract Infections in Adults and Children in Primary Care

In-Depth [randomized control study]: This multi-centered, randomized, double-blinded, placebo-controlled study took place across 42 general practice clinics in England between 2013-2015. Patients with acute sore throat were followed up for 28 days after randomization into either an intervention group of dexamethasone tablets (n = 293) or a control group with a placebo capsule (n = 283). The primary outcome was complete resolution of sore throat symptoms at 24 hours, reported by the patient through phone or text message. Secondary outcomes were complete resolution at 48 hours and the total duration of moderately severe symptoms as recorded in a validated 7-day symptom diary. After following up with patients at 24 hours, it was found that a single dose of oral dexamethasone did not significantly decrease the number of patients with complete sore throat resolution (22.6% of dexamethasone group, vs. 17.7% of placebo group; RR 1.28 [95% CI, 0.92-1.78, p = 0.14]). By 48 hours, 35.4% of patients in the dexamethasone group vs. 27.1% in the placebo group experienced complete resolution of symptoms (RR 131 [95% CI, 1.2%-16.2%]). Dexamethasone did not result in a significant difference in mean number of hours missed from work or education (mean difference 0.24 hours longer in dexamethasone group; 95%CI −2.14 to 2.61; p = 0.85), nor were there significant differences in the number of participants who required medical care at the emergency department, urgent care, or their GP clinic.

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