Intended for healthcare professionals

CCBYNC Open access
Practice Rapid Recommendations

Corticosteroids for sore throat: a clinical practice guideline

BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j4090 (Published 20 September 2017) Cite this as: BMJ 2017;358:j4090

Population

This recommendation applies to almost all patients with sore throat: People withsore throat Children and adults Emergency and primary care settings Patients with a viral or bacterial sore throat Severe and not severe sore throat Patients who receive immediate or deferred antibiotics However the recommendation is not applicable to patients with: Infectiousmononucleosis Immunocompromising conditions Sore throat following surgery or intubation

Choice of intervention

or Short course of steroids No steroids Standard clinical care, which typically includes analgesics, and may include antibiotics 1–2 doses of oral Dexamethasone(or equivalent dose of alternative corticosteroid) + standard care 10mg Adults: Children: Standard care Analgesics Antibiotics 0.6mg per kg + +/- + Standard care Analgesics Antibiotics + +/-

Recommendation

Favours steroids Favours no steroids

We suggest short course steroids. Discuss with patients in shared decision making. All Applies to Click for details Strong Benefits outweigh harms for almost everyone. All or nearly all informed patients would likely want this option. Weak Benefits outweigh harms for the majority, but not for everyone. The majority of patients would likely want this option. Weak Benefits outweigh harms for the majority, but not for everyone. The majority of patients would likely want this option. Strong Benefits outweigh harms for almost everyone. All or nearly all informed patients would likely want this option.

Comparison of benefits and harms

Favours Steroids Favours no steroids Evidence quality Events per 1000 people No important difference The panel found that these differences were not important for most patients, because the intervention effects were negligible and/or very imprecise (such as statistically not significant)

124 more Complete pain resolution (24 hrs) Moderate More 100 224

Risk of Bias No concerns Imprecision Serious Indirectness No concerns Inconsistency Due to imprecision Publication bias No concerns Corticosteroids probably increase the chance of complete resolution of pain at 24 hours

204 more More Complete pain resolution (48 hrs) High 629 425

Risk of Bias No concerns Imprecision No concerns Indirectness No concerns Inconsistency No concerns Publication bias No concerns Corticosteroids increase the chance of complete resolution of pain at 48 hours
Mean time to resolution (hours)

11.1 fewer More Complete pain resolution Low 33.0 44.0

Risk of Bias No concerns Imprecision Serious Indirectness No concerns Inconsistency Serious Publication bias No concerns Corticosteroids may shorten the duration of pain
Events per 1000 people

More Symptom recurrence or relapse Moderate 34 65 No important difference

Risk of Bias No concerns Imprecision Serious Indirectness No concerns Inconsistency No concerns Publication bias No concerns Corticosteroids probably have no important effect on the chance that symptoms recur

Antibiotics prescription Low 564 468 96 fewer More

Risk of Bias No concerns Imprecision Very serious Indirectness No concerns Inconsistency No concerns Publication bias No concerns Corticosteroids may decrease the chance of taking antibiotics in patients given a prescription with instructions to take the antibiotic if unimproved or worse.
See all outcomes
The panel believes that there is a great variability on how much reduction in pain severity or time to complete pain resolution each patient would consider important. Shared decision making may help establish what matters most to each patient. Preferences and values Serious adverse events Multiple doses One-dose administration of steroids is not likely to cause serious adverse events. Very low quality evidence exists for extremely rare but serious adverse effects following higher doses or longer courses of steroids (up to 30 days). Risks may outweigh benefits when cumulative doses of steroids are given for multiple episodes of sore throat. To mitigate this issue, clinicians could administer the medication in office if possible, or prescribing only one dose per visit. Key practical issues Steroids No steroids 1–2 doses, taken as pill(s) or intramuscular injection(s) No practical issues May cause transient sleep disturbance, and excitability Dexamethasone is generally avoided during pregnancy

©BMJ Publishing Group Limited.

Disclaimer: This infographic is not a validated clinical decision aid. This information is provided without any representations, conditions or warranties that it is accurate or up to date. BMJ and its licensors assume no responsibility for any aspect of treatment administered with the aid of this information. Any reliance placed on this information is strictly at the user's own risk. For the full disclaimer wording see BMJ's terms and conditions: http://www.bmj.com/company/legal-information/

Find recommendations, evidence summaries and consultation decision aids for use in your practice
Author Information

Please note:
  • Rapid responses are electronic comments to the editor. They are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles.
  • Your name will be published with your response. Include your email address in the text of your response if you want others to see it.
  • Once published, you will not have the right to remove or edit your response. The BMJ may remove or edit responses at its absolute discretion.
  • A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed
  • Rapid responses have their own URL and are retrievable in an advanced search of thebmj.com in perpetuity.
  • If patients could recognise themselves, or anyone else could recognise a patient from your description, please obtain the patient's written consent to publication before sending your response. See our patient consent form.
  • By submitting this rapid response your are agreeing to our full rapid response requirements.
  • Please do not include original data in your response, unless it has already been published in a peer reviewed journal and you are able to include a reference.

Note: this will be visible to readers on the site. Please only include information you are comfortable with being published.

Statement of Competing Interests

A competing interest exists when professional judgment concerning a primary interest (such as patients' welfare or the validity of research) may be influenced by a secondary interest (such as financial gain or personal rivalry). Find out more.

Compose eLetter

Plain text

  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Terms and Conditions

Read terms and conditions

Vertical Tabs