Corticosteroids for pain relief in sore throat: systematic review and meta-analysis

doi:10.1136/bmj.b2976

Published 6 August 2009, doi:10.1136/bmj.b2976
Cite this as: BMJ 2009;339:b2976

Research

Corticosteroids for pain relief in sore throat: systematic review and meta-analysis

Gail Hayward, academic F2 in general practice¹, Matthew Thompson, senior clinical scientist¹, Carl Heneghan, clinical lecturer in general practice¹, Rafael Perera, medical statistician¹, Chris Del Mar, dean, faculty of health sciences and medicine², Paul Glasziou, professor of evidence based medicine¹

¹ Department of Primary Health Care, University of Oxford, Oxford OX3 7LF , ² Bond University, Gold Coast, Queensland 4229, Australia

Correspondence to: M Thompson matthew.thompson{at}dphpc.ox.ac.uk

Objective To evaluate whether systemic corticosteroids improvesymptoms of sore throat in adults and children.

Design Systematic review and meta-analysis.

Data sources Cochrane Central, Medline, Embase, Database ofReviews of Effectiveness (DARE), NHS Health Economics Database,and bibliographies.

Outcome measures Percentage of patients with complete resolutionat 24 and 48 hours, mean time to onset of pain relief, meantime to complete resolution of symptoms, days missed from workor school, recurrence, and adverse events.

Results We included eight trials, consisting of 743 patientsin total (369 children, 374 adults). 348 (47%) had exudativesore throat, and 330 (44%) were positive for group A β-haemolyticstreptococcus. In addition to antibiotics and analgesia, corticosteroidssignificantly increased the likelihood of complete resolutionof pain at 24 hours (four trials) by more than three times (relativerisk 3.2, 95% confidence interval 2.0 to 5.1), and at 48 hours(three trials) to a lesser extent (1.7, 1.3 to 2.1). Corticosteroids(six trials) reduced mean time to onset of pain relief by morethan 6 hours (95% confidence interval 3.4 to 9.3, P<0.001),although significant heterogeneity was present. The mean timeto complete resolution was inconsistent across trials and apooled analysis was not undertaken. Reporting of other outcomeswas limited.

Conclusions Corticosteroids provide symptomatic relief of painin sore throat, in addition to antibiotic therapy, mainly inparticipants with severe or exudative sore throat.

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