Corticosteroid Treatment for Sore Throats

Sore throat (pharyngitis, or inflammation of the pharynx) is a very common complaint. It’s usually caused by a viral or bacterial infection, and less commonly by a fungal infection or other problem. One of the more common causes of sore throat is “strep throat,” which is a bacterial infection caused by Group A beta-meolytic Streptococcus. The treatment for a strep throat is an appropriate antibiotic, such as penicillin or azithromycin.

The diagnosis of streptococcal infection can be made by a “rapid” strep test, or by taking a swab of the throat and/or tonsils and then sending it to the microbiology laboratory to have it placed in culture medium to see if the bacteria will grow out and can be identified. Clinical diagnosis is not very accurate, because the combination of a red throat, pus (exudates) on the tonsils or in the throat, fever, and swollen lymph glands in the neck can be present with a viral infection, which is much more common than strep throat.

In an article entitled “Effectiveness of corticosteroid treatment in acute pharyngitis: a systematic review of the literature,” Andrew Wing and his colleagues (Academic Emergency Medicine 2010;17:476-483) sought to examine the effectiveness of corticosteroid treatment for relief of pain associated with acute sore throat potentially caused by group A beta-hemolytic Streptococcus. Looking at 10 published studies, they concluded that corticosteroid administration was associated with a relatively small effect in time to meaningful pain relief (shortening the time to relief by approximately four to five hours) and in overall pain relief at 24 hours after administration of the medication. They further concluded that “decision-making should be individualized to determine the risks and benefits; however, corticosteroids should not be used as routine treatment for acute pharyngitis.”

The mechanism by which corticosteroids are felt to help with relief from a severe sore throat is one of suppressing inflammation, which is the cause of pain and swelling of the soft tissues of the throat associated with the infection. Since the side effects from a single dose of corticosteroid, such as five to 10 mg of dexamethasone (adult dose), are minimal (if any), it seems reasonable to use the medication in conjunction with an antibiotic if the pain and swelling within the throat are severe.

What is severe? Severe pain is pain that is not relieved by non-narcotic medication. Severe swelling makes it difficult to swallow, and in some cases to speak. It may even affect the ability to breathe, although this is a fairly uncommon complication of a sore throat. In my first aid kit for an expedition, I carry antibiotics and a corticosteroid, because I have encountered situations where someone had a severe sore throat, and in my opinion, benefited from having the addition of a dose of corticosteroid added to the antibiotic. If someone has a minor or even moderate sore throat that I believe (or know) is streptococcal, then I prescribe the antibiotic alone.