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
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