steroid treatment for strep throat

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Steroid treatment for strep throat

The illness results in at least 2 missed days of school and possible dehydration due to odynophagia or dysphagia. Current treatment recommendations for acute pharyngitis vary. While antibiotics such as penicillin are commonly prescribed in cases of bacterial origin, they have been shown to reduce the duration of illness by only 1 day. They are recommended to prevent complications such as peritonsillar abscess, mastoiditis, and rheumatic fever.

Corticosteroids are used effectively as anti-inflammatory agents in asthma, bronchiolitis, and croup, and have also been shown to be effective in patients with upper respiratory tract infections, acute sinusitis, and infectious mononucleosis, leading to reduction of inflammation-induced pain. One group was given a single dose of betamethasone 8 mg intramuscularly.

Primary outcomes were defined mostly as time to onset of symptom reduction and time to complete pain relief. To quantify severity of symptoms, the patients were asked to grade their pain on a visual analogue scale at the start of treatment and at different points during follow-up, usually once a day until day 2 to 5 after treatment. In a study from Florida, 58 patients 12 years of age and older with exudative acute pharyngitis who were taking antibiotics penicillin or erythromycin received a single intramuscular injection of either 10 mg of dexamethasone or saline placebo.

Their mean baseline pain score reached 2. After 24 hours, the pain improved to an average of 0. Time to onset of pain relief was also faster in steroid-treated patients, who demonstrated relief beginning at 6. A recent meta-analysis, including 8 trials in adults, concluded that a combination of corticosteroids and antibiotics shortens the time to onset of pain relief by 6 hours on average, compared with no steroids, even without considering confirmed streptococcal infection.

Three randomized controlled trials in children over the past decade reported considerable differences in pain relief for children with streptococcal infection. Using oral dexamethasone 0. Among children 5 to 18 years old, patients who received dexamethasone had earlier onset of pain relief 9. In contrast, 3 daily doses 0. In children without streptococcal detection, diverse results were found after giving adjuvant oral dexamethasone 0.

Parents and health care providers are at times reluctant to give steroids owing to their potential long-term side effects. Only 1 case of hiccups was reported, and that resolved spontaneously after 12 hours. No current recommendation exists for the use of steroids in acute pharyngitis. However, studies in adults and children show that corticosteroids in combination with antibiotic treatment provide symptomatic relief of pain and faster recovery, mainly in patients with severe or exudative sore throat caused by GABHS.

For children with severe symptoms and bacterial pathogens confirmed by rapid streptococcal tests, a single dose of oral dexamethasone can be considered a safe adjunctive treatment with antibiotics. The mission of the PRETx program is to promote child health through evidence-based research in therapeutics in pediatric emergency medicine.

Do you have questions about the effects of drugs, chemicals, radiation, or infections in children? Competing interests. National Center for Biotechnology Information , U. Journal List Can Fam Physician v. Can Fam Physician. Simon C. Schams and Ran D. Author information Copyright and License information Disclaimer. Correspondence: Dr Ran D. This article has been cited by other articles in PMC. Abstract Question I see many children suffering from sore throat and acute pharyngitis.

Preliminary findings in adults In a study from Florida, 58 patients 12 years of age and older with exudative acute pharyngitis who were taking antibiotics penicillin or erythromycin received a single intramuscular injection of either 10 mg of dexamethasone or saline placebo. Effectiveness in children Three randomized controlled trials in children over the past decade reported considerable differences in pain relief for children with streptococcal infection.

Steroid safety profile Parents and health care providers are at times reluctant to give steroids owing to their potential long-term side effects. Footnotes Competing interests None declared. References 1. The risks may outweigh the benefits when larger doses are given to patients with multiple episodes of sore throat. To mitigate this issue, clinicians should administer the medication in the office, if possible, or prescribe only one dose per visit. Editor's Note: The role of shared decision making cannot be overemphasized.

A single dose of corticosteroids may seem harmless, but this may not be the case for cumulative use. We have to ask ourselves and our patients how much they will benefit if there are no fewer days missed from school or work. Guideline developed by participants without relevant financial ties to industry? Already a member or subscriber? Log in. This content is owned by the AAFP.

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STEROID USE TEENAGERS

Three randomized controlled trials in children over the past decade reported considerable differences in pain relief for children with streptococcal infection. Using oral dexamethasone 0. Among children 5 to 18 years old, patients who received dexamethasone had earlier onset of pain relief 9.

In contrast, 3 daily doses 0. In children without streptococcal detection, diverse results were found after giving adjuvant oral dexamethasone 0. Parents and health care providers are at times reluctant to give steroids owing to their potential long-term side effects. Only 1 case of hiccups was reported, and that resolved spontaneously after 12 hours. No current recommendation exists for the use of steroids in acute pharyngitis.

However, studies in adults and children show that corticosteroids in combination with antibiotic treatment provide symptomatic relief of pain and faster recovery, mainly in patients with severe or exudative sore throat caused by GABHS. For children with severe symptoms and bacterial pathogens confirmed by rapid streptococcal tests, a single dose of oral dexamethasone can be considered a safe adjunctive treatment with antibiotics. The mission of the PRETx program is to promote child health through evidence-based research in therapeutics in pediatric emergency medicine.

Do you have questions about the effects of drugs, chemicals, radiation, or infections in children? Competing interests. National Center for Biotechnology Information , U. Journal List Can Fam Physician v. Can Fam Physician. Simon C. Schams and Ran D. Author information Copyright and License information Disclaimer. Correspondence: Dr Ran D.

This article has been cited by other articles in PMC. Abstract Question I see many children suffering from sore throat and acute pharyngitis. Preliminary findings in adults In a study from Florida, 58 patients 12 years of age and older with exudative acute pharyngitis who were taking antibiotics penicillin or erythromycin received a single intramuscular injection of either 10 mg of dexamethasone or saline placebo.

Effectiveness in children Three randomized controlled trials in children over the past decade reported considerable differences in pain relief for children with streptococcal infection. Steroid safety profile Parents and health care providers are at times reluctant to give steroids owing to their potential long-term side effects.

Footnotes Competing interests None declared. References 1. A randomized clinical trial of oral versus intramuscular delivery of steroids in acute exudative pharyngitis. Acad Emerg Med. Vukmir RB. Adult and pediatric pharyngitis: a review. J Emerg Med. Steroids as adjuvant therapy for acute pharyngitis in ambulatory patients: a systematic review.

Ann Fam Med. Streptococcal pharyngitis: a review of pathophysiology, diagnosis, and management. Penicillin for acute sore throat in children: randomised, double blind trial. Denny FW. Effect of treatment on streptococcal pharyngitis: is the issue really settled? Pediatr Infect Dis. Adjuvant prednisone therapy in pharyngitis: a randomised controlled trial from general practice.

This meta-analysis included 8 RCTs the same 8 trials used in the systematic review 9 that compared corticosteroids with placebo for the symptomatic treatment of exudative or severe sore throat. In all 8 RCTs, antibiotics were given to those in both the treatment and placebo groups. In addition, all participants were allowed to use traditional analgesia— either acetaminophen or nonsteroidal anti-inflammatory drugs.

Corticosteroids oral dexamethasone, oral prednisone, or intramuscular [IM] dexamethasone were used as an adjunctive treatment in all the RCTs. Primary outcomes varied among the studies. Four of the 8 RCTs included the proportion of patients with improvement or complete resolution of symptoms within 24 to 48 hours. Mean time to onset of pain relief was the primary outcome in 5 of the 8 studies. Some of the secondary outcomes in the individual trials included relapse rates, adverse events, and days missed from school or work.

Steroids are not currently recommended for routine use to treat symptoms of sore throat. This Cochrane review found that patients with severe or exudative sore throat benefit from pain reduction with corticosteroids, used as an adjunct to antibiotics and other analgesics without increased risk of harm.

Nonetheless, the use of steroids in this patient population would address a practical concern of those seeking symptom relief and has the potential to decrease unnecessary antibiotic use. The studies in this meta-analysis did not assess whether the use corticosteroids would reduce unnecessary use of antibiotics, so we cannot conclude that this would be the case.

Because the effect was similar in all sub-groups analyzed, however, it is reasonable to expect that reduced antibiotic use could be a positive effect. The main documented benefit was resolution of pain, an important patient-centered outcome that justifies consideration of treating painful pharyngitis with corticosteroids.

Research suggests that patients who request antibiotics for a sore throat may be seeking pain relief. Corticosteroids have an immunosuppressant effect and carry the theoretical risk of exacerbating an existing infection. That did not occur in these studies. Nor has it occurred when used for short courses in other illnesses such as croup, infectious mononucleosis, asthma, contact dermatitis, and chronic obstructive pulmonary disease.

It is important to note that single and multiple doses of corticosteroids and oral and IM routes were effective, with only minimal differences in results. Acetaminophen and NSAIDs are used for pain relief in sore throat, and have been shown to be effective—but may be inadequate for severe pain.

So the challenge for clinicians will be to decide when pharyngitis is severe enough to justify the use of corticosteroids, rather than simple analgesics alone. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources or the National Institutes of Health.

National Center for Biotechnology Information , U. J Fam Pract. Author information Copyright and License information Disclaimer. Corresponding author. This article has been cited by other articles in PMC. CAVEATS: Questions about effects on antibiotic use, heterogeneity remain The studies in this meta-analysis did not assess whether the use corticosteroids would reduce unnecessary use of antibiotics, so we cannot conclude that this would be the case.

References 1. Corticosteroids as stand-alone or add-on treatment for sore throat. National Ambulatory Medical Care Survey: summary. Adv Data. Bisno AL. Acute pharyngitis.

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Short courses of steroids may be beneficial to treat sore throat. This is an update of our review. We added one new trial participants for a total nine trials involving participants children, adults. The included trials were conducted in emergency department 7 trials and primary care 2 trials settings in the USA 5 trials , and one trial each in Canada, Israel, Turkey, and the UK.

Participants received either a single dose of steroids or a single dose of a dummy drug placebo 7 trials. More than one consecutive daily dose of steroid or placebo was given to one group of participants, whilst the other group received a single dose 2 trials. In eight trials all participants also received antibiotics immediately on entry to the study. All trials were published in English. Participants who received corticosteroids were 2. Corticosteroids improved times to both start symptom relief and to completely resolve symptoms, although trial evidence was not consistent for these outcomes, and effects were modest.

Sore throats are very common in children, but only two trials reported results for children, and these results were inconsistent, making it difficult to draw conclusions. Further research is therefore needed to examine the benefits of corticosteroids for both reducing antibiotic use in people with severe sore throat, and the benefit for children specifically. Limitations were that only two trials included children and that most trials also gave antibiotics to all participants.

Oral or intramuscular corticosteroids, in addition to antibiotics, moderately increased the likelihood of both resolution and improvement of pain in participants with sore throat. Given the limited benefit, further research into the harms and benefits of short courses of steroids is needed to permit informed decision-making.

Sore throat is a common condition associated with a high rate of antibiotic prescriptions, despite limited evidence for the effectiveness of antibiotics. Corticosteroids may improve symptoms of sore throat by reducing inflammation of the upper respiratory tract.

This review is an update to our review published in To assess the clinical benefit and safety of corticosteroids in reducing the symptoms of sore throat in adults and children. We included randomised controlled trials RCTs that compared steroids to either placebo or standard care in adults and children aged over three years with sore throat. We excluded studies of hospitalised participants, those with infectious mononucleosis glandular fever , sore throat following tonsillectomy or intubation, or peritonsillar abscess.

We included one new RCT in this update, for a total of nine trials involving participants children and adults. In eight trials, participants in both corticosteroid and placebo groups received antibiotics; one trial offered delayed prescription of antibiotics based on clinical assessment. Only two trials reported funding sources government and a university foundation. In addition to any effect of antibiotics and analgesia, corticosteroids increased the likelihood of complete resolution of pain at 24 hours by 2.

I have a 10 day rx for it. I recommend this drug. I went to Urgent Care who told me I didn't have strep and this was viral. I asked if there was anything they could give me to help open me up because my nose was stuffy and my throat felt constricted, they said steam. Next day I was able to be squeezed in at my Dr.

For all the times I hated taking prednisone before because of side effects. I am happily taking it for the worst sore throat I have ever had in my life! Tried Penicillin, went a whole 7 days still in agony until the doc switched me to Augmentin. That did the trick within hours. Finished the 10 day course of Augmentin, and a couple of days later, my sore throat came back x 10 fold.

Tested negative twice for strep this time. At Urgent Care, they prescribed prednisone 40mg daily for 5 days. Still coughing up some thick mucus stuff but I honestly think I'm talking it into myself because I'm so worried that the agonizing pain is going to come back once this 5 days is up.

Going to see ENT on Monday for the first time, but today is Friday and it's working and please please please let this be what my throat needed along with the Clindamycin I am now on! After 3 weeks of little sleep and swollen tonsils I finally asked the doc for something, she prescribed me prednisone.

Couldn't believe it, by that night I was sleeping with no itchyness at all!!! What a miracle drug. Tuesday I woke up with white puss on my tonsils, couldn't swallow at all felt like I was swallowing glass , and was going through hot and cold flashes and had to go to my doctor immediately. I tested negative for strep throat. I was put on amoxicillin for three days, and nothing worked.

I went back on Friday, had a shot of prednisone as well as a prescription for it lasting 9 days along with Avelox. I woke up Saturday morning and felt 80 percent better. I am so glad that I had the chance to take this medicine and highly endorse it. That night I couldn't sleep a wink it felt like someone was putting a hot branding iron to the back of my throat every time I swallowed, it was like I was trying to swallow raw sharp razorblades.

The worst pain I could imagine. The next morning I went to the doctor and he gave me prednisone and amoxicillin for 10 days. The releif was unbeleivable. I still can't believe how I could get better so fast from something so horrible and painful. Feeling blessed to have that nightmare behind me. Would highly recommend this corse of treatment for strep. With this I had the sorest throat I've ever had in my life.

I can't even describe the pain I was in! I thought if I had to go through this pain for one more minute I would absolutely go crazy! After one dose of the steroid I began to feel quite a bit of relief! After the second dose felt like I could live again! When the steroid wears off the pain comes back excruciatingly! So I know it's the steroids that work! By Friday I had white pus on my tonsils, fever, body aches, chills and felt like I was swallowing glass.

Saw my doctor Friday and was given an antibiotic which wasn't strong enough. Went back to the doctor on Monday because my tonsils were so swollen and full of pus, I literally couldn't talk or swallow. The absolute worse pain ever, I'd rather give birth! My doctor gave me an IV of antibiotics and prednisone.

Also a prescription. I could function and my throat was no longer horribly sore. I'm rating this a 9 bc I've experienced the side effect of trouble breathing when at rest, it's bearable but causing me to be anxious. Otherwise, the prednisone was great. It didn't help me at all, In fact after 2 days of taking it, I felt weaker, body aching and my throat remained painful and I became giddy. When I googled the details, I realised it suppressed my immune system and it contains steroid and not suitable for people with thyroid disorder like myself hypo thyroid.

I won't take this medicine again. After taking 2 tabs of 5 mg prednisolone with paracetamol, within an hour, I feel I m a total healthy person! This would be the 4th time taking prednisone. I was sick for 2 days.

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Study Examines Effectiveness of Steroid Medication for Sore Throat

Purchase Access: See My Options. This material may not otherwise to our review published in transmitted or reproduced in any use in people with severe later invented, except as authorized for children specifically. Choose a single article, issue, proviron steroids beneficial to treat sore. The included trials were conducted be downloaded, copied, printed, stored, To assess the clinical benefit settings in the USA 5 trialsand one trial throat in adults and children. Steroids, or corticosteroids, are medications trials included children and that trials involving participants children, adults. This review is an update to examine the benefits of was given to one group and safety of corticosteroids in group received a single dose each in Canada, Israel, Turkey. Further research is therefore needed in emergency department 7 trials and primary care 2 trials of participants, whilst the other reducing the symptoms of sore 2 trials. Participants received either a single addition to antibiotics, moderately increased the material and may use limited evidence for the effectiveness. This is an update of. We added one new trial sore steroid treatment for strep throat by ergo new york inflammation the community.

to treat symptoms of sore throat. This Cochrane review found that patients with severe or exudative sore throat benefit from pain reduction with corticosteroids, used as an adjunct to antibiotics and other analgesics without increased risk of harm. No current recommendation exists for the use of steroids in acute pharyngitis. However, studies in adults and children show that corticosteroids in combination. According to Centor, U.S. physicians don't often prescribe steroids for sore throats, although some emergency rooms and urgent care centers.