Soothing a sore throat: the efficacy and safety of steroids in acute pharyngitis

Acute pharyngitis is a common presentation to Emergency Departments (EDs) and although most patients experience mild-to-moderate discomfort, severe pharyngitis can be incapacitating and painful. There have been recent trends in prescribing steroids to provide pain relief for patients with acute pharyngitis.

To examine the evidence for using steroids in adult patients with acute pharyngitis attending Emergency Departments.

A comprehensive literature search was performed to identify randomised controlled trials, systematic reviews and meta-analyses. The primary outcome measure assessed was pain relief, while safety of steroids was chosen as a secondary outcome measure.

Six papers met the inclusion criteria—five randomised controlled clinical trials and one systematic review (adult and paediatric patients in a variety of clinical settings). Mean times to onset of pain relief were shorter in patients receiving steroids (8.1 vs. 19.9 h, 6.3 vs. 11.3 h, 6.3 vs. 12.4 h). A single study examining reduction in VAS pain scores found a statistically significant improvement in patients given steroids (PO: 4.2 ± 2.3, IM: 3.8 ± 2.3 vs placebo: 2.0). Marvez-Valls et al. reported shorter times to complete pain relief (43 vs. 36 h) but this and other studies failed to demonstrate a statistically significant reduction in the pain scores at 24 h. Frequency and nature of side effect reporting was inconsistent throughout the studies with no trials explicitly powered to detect clinically important adverse events.

Steroids may provide a useful adjunct in the management of acute pharyngitis, but there is currently insufficient evidence to endorse routine use.