Corticosteroids for sore throat: do the benefits outweigh the harms?
This article (1) recommends a major change to the management of sore throat in the UK; quite apart from the issue of the increased workload which this would create, I am not convinced that the possible small benefit justifies the risks. By my calculation, the most recent trial included in the review (2) had a NNT of 12 for patients with sore throat who were given dexamethasone being pain-free after 48 hours. That is not impressive.
The authors state that "A single dose of corticosteroids is unlikely to cause serious adverse events". However a recent US cohort study (3) showed that short courses of oral steroids are associated with a fivefold increase in the risk of sepsis in the following 30 days, as well as a threefold risk of VTE and double the risk of fractures. The courses used in this article were for a median dose of 20mg prednisolone and a median duration of 6 days (120mg in total). This new guideline recommends using 10mg of dexamethasone: a high dose of oral steroid, equivalent to 65 mg prednisolone (130mg in total if given for two days).
Certainly oral steroids should be considered as an option for the patient in severe pain, but I do not believe that the existing evidence justifies their routine prescription.
1. Aertgeerts Bert, Agoritsas Thomas, Siemieniuk Reed A C, Burgers Jako, Bekkering Geertruida E, Merglen Arnaud et al. Corticosteroids for sore throat: a clinical practice guideline BMJ 2017; 358 :j4090
2. Hayward GN, Hay AD, Moore MV, et al. Effect of oral dexamethasone without immediate antibiotics vs placebo on acute sore throat in adults: a randomized clinical trial. JAMA2017;358:1535-43
3. Waljee Akbar K, Rogers Mary A M, Lin Paul, Singal Amit G, Stein Joshua D, Marks Rory M et al. Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study BMJ 2017; 357 :j1415
Competing interests: No competing interests