Acute sore throat is one of the most common infections presenting to primary care, with almost one in 10 people consulting annually. Antibiotics are prescribed in 60% of UK primary care sore throat consultations and the trend is not decreasing despite little symptomatic benefit and national guidelines advising against prescriptions. There is a need to find alternative strategies that reduce symptoms, reduce the burden of acute illness and reduce antibiotic consumption.
Although studies had shown that steroids in addition to antibiotics worked better than antibiotics alone to improve the symptoms of sore throat, evidence for corticosteroids for sore throat in primary care in the absence of antibiotics is still lacking. The primary aim of the TOAST (Treatment Options without Antibiotics for Sore Throat) trial was to investigate whether a single dose of oral dexamethasone compared with placebo increased resolution of symptoms at 24 hours after consultation. Participants were adults aged 18 and over with acute sore throat not requiring immediate antibiotic therapy.
565 patients were recruited from GP practices in south and west England, 288 patients received dexamethasone and 277 placebo. The results, published in JAMA on 18 April, show that although there was not much change in symptoms after 24 hours, after 48 hours significantly more participants experienced complete resolution in the dexamethasone group. However, for practicing GPs this effect has to be balanced against the side effects of steroids, the risk that more patients would come to see their GP if steroids were offered, and the lack of effect on measures such as time away from work, use of antibiotics and overall symptom burden.
and blog by Dr Gail Hayward: Can steroids soothe the thorny issue of acute sore throat?
April edition of JAMA Highlights: Dexamethasone for Acute Sore Throat