Oxford, U.K.—What is the role of corticosteroids in resolving severe sore throat in adults, especially if use of the drugs could speed symptom resolution without antibiotics?

The answer is mixed, according to a new study appearing in JAMA.

University of Oxford–led researchers determined that, as of 24 hours, patients at 42 family practices in South and West England who received dexamethasone had complete symptom resolution at no higher rates than those getting a placebo. Results didn’t differ much among those who were not offered an antibiotic prescription and those who were offered a delayed antibiotic prescription.

At 48 hours, however, more participants receiving dexamethasone than placebo reported complete symptom resolution, whether or not they were offered delayed antibiotics. At the same times, days missed from work or school or other adverse events didn’t differ much among the 565 participants.

Background information in the article describes how corticosteroids inhibit transcription of proinflammatory mediators in airway endothelial cells, which are responsible for pharyngeal inflammation and pain symptoms.

In the study, Treatment Options Without Antibiotics for Sore Throat (TOAST), the primary objective was to determine whether adults with acute sore throat not requiring immediate antibiotic therapy would experience one-day symptom reduction with a single dose of oral dexamethasone versus placebo.

Results indicate that, at 24 hours, 22.6% in the dexamethasone group and 17.7% in the placebo group achieved complete resolution of symptoms, for a risk difference of 4.7% and a relative risk of 1.28. At 48 hours, 35.4% in the dexamethasone group reported total reduction of symptoms, compared to 27.1% in the placebo group, for a risk difference of 8.7% and a relative risk of 1.31. Results also indicate that, in participants not offered delayed antibiotic prescription, the risk difference was 10.3%. with a relative risk of 1.37.

In response to their less-than-conclusive results, study authors urged more research, noting that sore throats resulted in 92 million estimated visits by adults to primary care practices and emergency departments in the United States between 1997 and 2010, at a cost of more than $6.6 million annually. In the U.K., meanwhile, antibiotics are prescribed at 60% of primary care sore-throat consultations, with no decrease in sight, even though national guidelines seek to curb their use.

“There is a need to find alternative strategies that reduce symptoms, reduce the burden of acute illness, and reduce antibiotic consumption,” the researchers point out.

“Corticosteroids may have clinical benefit in addition to antibiotics for severe sore throat, for example, to reduce hospital admissions of those patients who are unable to swallow fluids or medications. There have been no trials of corticosteroid use involving these patient groups,” the authors conclude.

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