A dose of Dex?

I have a confession.  For as long as I can remember I have been prescribing a dose of dexamethasone or two for people with acute tonsillo-pharyngitis.  Now, I always thought this was a little bit naughty, not really “the done thing” for a doc who tries to be evidence-based.  But over the years I have always found it to be quite effective.  Even tried it myself a few times!

Now to be clear – I am not using it for every sore throat I see.  I tend to use it in the sick, really nasty-looking, not drinking, might need admission sore throats.  Or sometimes in people who need to get well quickly – e.g. me.

Now the Cochrane folk have released a review of the evidence for steroids in acute tonsillitis or pharyngitis.  And guess what – it just might be an effective therapy.  Check out the full Cochrane review here.

If you are too busy to read that big document there was a quick chat on the ABC Health program: Norman Swan: ABC Health Report, in which Dr Swan interviews public health guru Professor Paul Glasziou.

In summary the RCTs showed:

– a benefit in terms of reduction in pain – a good patient-based outcome

– the benefit was pretty early i.e. 24 hours on average

– The same was seen in kids and adults

– no real difference between bacterial or viral pharyngitides – do we know which is which anyway?

– Unfortunately the studies all included antibiotics in addition to steroids  – so potentially confounded the data.

I think I will keep using a dose of Dex [dexamethasone] for the bad throats for now.  I think we need a solid head-to-head trail to compare steroids to placebo in patients who get no antibiotics.  Maybe a third arm for ibuprofen?  Would be a good study to read.

What say you?      Casey


  1. Back in 2004…… BBs looked at this and concluded that there was evidence back then. Looks like we need an update, but you have already got there.

    Interestingly we have not seen a take up of it in the UK (to my knowledge anyway), so your post is a great one to re-ignite the debate.

    Cheers Casey.


    • We need a trial of naked steroids vs placebo. Shouldn’t be too hard?
      In the mean time I say to patients: if you want ABs then try this first. If not improving or worse follow up. Less ABs, less pain, patient empowered. Unlikely to get common side effects at low dose for 1-2 days

  2. I’ve been doing this for about 3 or 4 years now -- as you say for the really miserable ones. Because of the nature of ED it’s hard to know how much success I’ve got from it but I view it as a cheap and easy and fairly benign intervention. Sore throat is all about symptomatic management and it’s another arrow in the quiver.

  3. Emma Griffiths says:

    I used this in a difficult patient on the third presentation for what seemed consistent with viral pharyngitis (without antibiotics) and he rang up to thank me for the magic pills 🙂

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