Corticosteroids for pain relief in sore throat: systematic review and meta-analysis
BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b2976 (Published 06 August 2009) Cite this as: BMJ 2009;339:b2976
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- 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
- 1Department of Primary Health Care, University of Oxford, Oxford OX3 7LF
- 2Bond University, Gold Coast, Queensland 4229, Australia
- Correspondence to: M Thompson matthew.thompson{at}dphpc.ox.ac.uk
- Accepted 23 March 2009
Abstract
Objective To evaluate whether systemic corticosteroids improve symptoms of sore throat in adults and children.
Design Systematic review and meta-analysis.
Data sources Cochrane Central, Medline, Embase, Database of Reviews of Effectiveness (DARE), NHS Health Economics Database, and bibliographies.
Outcome measures Percentage of patients with complete resolution at 24 and 48 hours, mean time to onset of pain relief, mean time to complete resolution of symptoms, days missed from work or school, recurrence, and adverse events.
Results We included eight trials, consisting of 743 patients in total (369 children, 374 adults). 348 (47%) had exudative sore throat, and 330 (44%) were positive for group A β-haemolytic streptococcus. In addition to antibiotics and analgesia, corticosteroids significantly increased the likelihood of complete resolution of pain at 24 hours (four trials) by more than three times (relative risk 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 more than 6 hours (95% confidence interval 3.4 to 9.3, P<0.001), although significant heterogeneity was present. The mean time to complete resolution was inconsistent across trials and a pooled analysis was not undertaken. Reporting of other outcomes was limited.
Conclusions Corticosteroids provide symptomatic relief of pain in sore throat, in addition to antibiotic therapy, mainly in participants with severe or exudative sore throat.
Footnotes
We thank Nia Roberts, Ed Diggines, and Emma Meats for their assistance with literature searching and organisation.
Contributors: GH performed the study appraisal, meta-analysis, wrote the first draft of the article, made critical revisions to the article, and is guarantor for this article. MT obtained grant funding, organised the research study, supervised the searching, appraisal, interpretation, and made critical revisions to the article. CH assisted with the searching, appraisal, meta-analysis, and made critical revisions to the article. RP supervised the meta-analysis, revised and commented on various drafts of the article, and provided methodological support. CDM drafted, revised, and commented on various drafts of the article and read and approved the final draft. PG drafted, revised, and commented on various drafts of the article; and read and approved the final draft.
Funding: Funding for this work was provided in part by a grant from the British Society for Antimicrobial Chemotherapy Systematic Review Grant (GA722SRG). The Department of Primary Health care is part of the NIHR School of Primary Care Research. The study sponsors had no role in the study design; in the collection, analysis, or interpretation of data; in the writing of the report; nor in the decision to submit the article for publication.
Competing interests: None.
Ethical approval: Not required.
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