Article Figures & Data
Figures
- Figure 1.
Literature search results.
RCT=randomized controlled trial.
Tables
Study, Year, Country Setting (n) Mean Age, y Interventiona Co-Intervention Bacteriology Main Outcomes Main Results Authors’ Conclusions Exp=experimental; GABHS=group A β-hemolytic streptococci, IM=intramuscular; VAS=visual analogue scale. a All control groups received placebo. O’Brien et al,9 1993, USA Educational (51) 26.4 0 mg dexamethasone IM Antibiotic: yes Analgesic: permitted, controlled None 15-cm VAS (0–3.0) pain score at 24 h Time until onset of pain relief Time to complete pain relief 6.1-h earlier onset of pain relief (6.3 h vs 12.4 h; P=.01) 20.4-h earlier pain free (15 h vs 35.4 h; P = .02) in the steroid arm “IM dexamethasone appears effective as an adjuvant to antibiotic therapy“ Marvez-Valls et al,7 1998, USA Educational (92) 29.2 12 mg beta-methasone IM Antibiotic: yes Analgesic: permitted, not controlled In 77 of 92 patients done 10-cm VAS pain score at 24 h and 48 h Change in pain score at 24 h and 48 h Time until onset of pain relief Time to complete pain relief 5-h earlier onset of pain relief (6.3 h vs 11.3 h; P=.005), 13.8-h earlier pain free (42.0 h vs 55.8 h; P = .013) in the steroid arm If GABHS positive: 28.2-h earlier pain free (28.8 h vs 57.0 h; P=.024) in the steroid arm “As an adjunct to antibiotic therapy, betamethasone appears to lessen time to relief of pain…most effective in streptococcal-positive pharyngitis” Wei et al,8 2002, USA Educational (118) 28.1 10 mg dexamethasone IM/oral Antibiotic: yes Analgesic: permitted, controlled Yes Change in 10-cm VAS pain score after 12 h and 24 h Time until onset of pain relief Time to complete pain relief 4-h earlier onset of pain relief (5.8 h IM/6 h oral vs 10.1 h placebo; P = .029) in the steroid arm “Dexamethasone at a 10-mg …, significantly contributes to relief of pain” Kiderman et al,6 2005, Israel General practice (79) 33.9 60 mg prednisone oral 1 or 2 d Antibiotic: yes Analgesic: permitted, controlled In 73 of 79 patients done 10-cm VAS pain score at 12 h, 24 h, 48 h, 72 h Pain reduction at 12 h (3.9 vs 5.9 P <.001) and 24 h (2.4 vs 4.5; P=.002) in the steroid arm “…adjuvant oral steroid therapy appears to be safe and more effective than placebo for symptom relief“ Tasar et al,10 2008, Turkey Educational (73) 31.3 8 mg dexamethasone IM Antibiotic: yes Analgesic: permitted, not controlled None Time until onset of pain relief Time to complete pain relief 11.8-h earlier onset of pain relief (8.1 h vs 19.9 h; P <.001) 24.8-h earlier pain free (28.9 h vs 53.7 h; P <.001) in the steroid arm “Single dose…dexamethasone therapy added to the standard treatment has a more rapid improvement of pain” Study, Year, Country Setting (n) Mean Age, y Interventiona Co-Intervention Bacteriology Main Outcomes Main Results Authors’ Conclusions CI=confidence interval; Exp=experimental; GABHS=group A β-hemolytic streptococci, VAS = visual analogue scale. a All control groups received placebo. b Median age. Bulloch et al,11 2003, USA Educational (184) 9.7 10 mg dexamethasone oral Antibiotic: yes if rapid antigen test positive for GABHS Analgesic: permitted, not controlled Yes 10-cm VAS pain score at 24 h Change in pain score at 24 h Time until onset of pain relief Time to complete pain relief If GABHS positive: 5.5 h earlier onset of pain relief (6.0 h vs 11.5 h; P = .02) in the steroid arm “…oral dexamethasone does not decrease the time to onset of clinically significant pain relief or the time to complete pain relief” Olympia et al,12 2005, USA Educational (125) 11.4 Maximum 10 mg dexamethasone (0.6 mg/kg) oral Antibiotic: yes if rapid antigen test positive for GABHS Analgesic: permitted, Yes Change in McGrath Facial Affective scale pain score at 24 h and 48 h Time until onset of pain relief Time to complete pain relief If GABHS positive: 5.1 h (95% CI, 0.5–10.8 h) earlier onset of pain relief (9.7 h vs 14.8 h) in the steroid arm “Immunocompetent children with moderate to severe pharyngitis benefited from the use of oral dexamethasone” Niland et al,13 2006, USA Educational (84) 8b Maximum 10 mg dexamethasone (0.6 mg/kg) oral, 1 or 3 d Antibiotic: yes Analgesic: permitted, controlled Yes Time until onset of pain relief Time improvement of general condition Time to improvement of activity level in days 1 d earlier onset of pain relief (1 d vs 2 d) in the steroid arm “…children with acute uncomplicated GABHS pharyngitis who receive steroids as add-on treatment are likely to convalesce faster” Study, Year, Country Random- ization Adequate Primary Outcome Defined Dropouts Described Point Estimates/ Measures of Variability Intention- to-Treat Power Calculation Described Double- Blinding Eligibility Criteria Predefined O’Brien et al,9 1993, USA Yes Unclear Yes Yes No No Yes Yes Marvez-Valls et al,7 1998, USA Yes Yes Yes (no drop-outs) Yes No Yes Yes Yes Wei et al, 2002,8 USA Unclear Unclear Yes Yes No No Yes Yes Kidermann et al,6 2005, Israel Yes Yes Yes (no drop-outs) Yes No Yes Yes Yes Tasar et al,10 2008, Turkey Yes No Yes (no drop-outs) Yes No No Yes Yes Bulloch et al,11 2003, USA Yes No Yes Yes No Yes Yes Yes Olympia et al,12 2005, USA Yes Yes Yes Yes No Yes Yes Yes Niland et al,13 2006, USA Yes Yes Yes Yes Yes Yes Yes Yes
Supplemental Appendix
Supplemental Appendix. Search Terms
Files in this Data Supplement:
- Supplemental data: Appendix - PDF file, 1 page 52 KB
The Article in Brief
Steroids as Adjuvant Therapy for Acute Pharyngitis in Ambulatory Patients: A Systematic Review
Jean-Francois Chenot , and colleagues
Background Antibiotics may shorten the duration of symptoms of a bacterial throat infection, but the benefits are considered moderate. Steroids, which are anti-inflammatory, might be effective in relieving symptoms. This study examines existing research to determine the effectiveness of steroids for treating sore throat.
What This Study Found Steroids are effective in relieving sore throat pain in adult and pediatric patients, with no serious adverse effects from the different steroids administered. The authors state that it is debatable whether earlier pain relief justifies the administration of steroids, particularly as there are safe and effective over-the-counter medications to relieve sore throat pain. In addition, the benefits of steroid use must be weighed against possible rare adverse drug effects.
Implications
- Further studies are needed to establish the safety of steroid use without antibiotic coverage and the added benefits of steroids when used with over-the-counter analgesic medications.
Annals Journal Club:
Jan/Feb 2010
Steroids to Reduce Pain in Acute Pharyngitis
The Annals of Family Medicine encourages readers to develop a learning community of those seeking to improve health care and health through enhanced primary care. You can participate by conducting a RADICAL journal club and sharing the results of your discussions in the Annals online discussion for the featured articles. RADICAL is an acronym for Read, Ask, Discuss, Inquire, Collaborate, Act, and Learn. The word radical also indicates the need to engage diverse participants in thinking critically about important issues affecting primary care and then acting on those discussions.1How it Works
In each issue, the Annals selects an article or articles and provides discussion tips and questions. We encourage you to take a RADICAL approach to these materials and to post a summary of your conversation in our online discussion. (Open the article online and click on "TRACK Comments: Submit a response.") You can find discussion questions and more information online at: http://www.AnnFamMed.org/AJC/.
CURRENT SELECTION
Article for Discussion
- Korb K, Scherer M, Chenot JF. Steroids as adjuvant therapy for acute pharyngitis in ambulatory patients: a systematic review. Ann Fam Med. 2009; 8(1):58-63.
Discussion Tips
This article provides an opportunity to consider an uncommon treatment for a common problem, and also to examine methods for systematic reviews.Discussion Questions
- What questions are addressed by this article? How do the questions fit with what already is known on this topic?
- How does the way the questions were framed affect the utility of the findings?
- How strong are the study designs for answering the questions?
- To what degree can the findings be accounted for by:
- How studies were selected or excluded?
- Heterogeneity in how the treatments or outcomes were assessed?
- Confounding (false attribution of causality because 2 variables discovered to be associated actually are associated with a third factor)?
- Researcher bias?
- Chance?
- How does the quality assessment of the articles (shown in Table 3) relate to other methods for assessing study quality, such as the CONSORT Guidelines for clinical trials: http://www.consort-statement.org/consort-statement/, the Strength of Recommendation Taxonomy (SORT): http://www.aafp.org/afp/20040201/548.html, or other systems to rate the strength of scientific evidence: http://www.ahrq.gov/clinic/epcsums/strengthsum.htm?
- What are the main study findings?
- What can we learn from the subgroup analyses?
- How comparable are the study populations to your practice? What is your judgment about the transportability of the findings?
- How (if at all) could this study change your practice?
- What important researchable questions remain?
References
- Stange KC, Miller WL, McLellan LA, et al. Annals journal club: It�s time to get RADICAL. Ann Fam Med. 2006;4(3):196-197. http://annfammed.org/cgi/content/full/4/3/196.
