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The Treatment Options without Antibiotics for Sore Throat (TOAST) project, a collaborative study organised through Oxford, Southampton and Bristol Universities, has reached its initial recruitment target of 566 randomized patients across 40 practices on time.

Toast recruitment target is reached

Almost one in 10 registered patients will see their GP every year with sore throat. Sore throat is estimated to cost £430 million annually in consultations and lost productivity alone.

91% of those diagnosed with tonsillitis will receive antibiotics, as will half of those recorded as 'sore throat' or 'pharyngitis'. NICE guidance recognises the limited evidence for benefit of antibiotics in its advice to avoid prescriptions in most patients. However, prescribing rates remain disproportionately high. An alternative symptomatic treatment could reduce both unnecessary antibiotic prescribing and the economic burden of sore throat.

In a BMJ systematic review, researchers say that patients with sore throat receiving a single dose of steroids were three times more likely to experience complete resolution of pain at 24 hours and experienced pain relief six hours earlier. However, all of the patients received antibiotics, and few were recruited from primary care.

The team propose a randomised, placebo controlled, blinded trial design in patients aged between 18 and 70 years presenting to the GP with acute sore throat. Patients will receive a single dose of either oral dexamethasone (10mg) or identical placebo. Patients, clinicians and researchers will be blinded. Where an antibiotic is indicated according to NICE guidance, a delayed prescription will be provided.

This has been a real team effort and a target which would not have been achieved without the commitment from our recruiting practices over the last two years and all of the coordinators at our collaborating centres. We’re looking forward to seeing the results later in the year!"
- Julie Allen, TOAST trial manager

The team have an international reputation in respiratory infection research, with previous successful clinical trials in this area and collaborations with School partners on a relevant trial (OSAC trial). We will draw logistic support from our clinical trials unit.

Trial manager Julie Allen thanks Johanna Cook, Jenni Swettenham, Helen Thorp, Lin Bigwood, Kim Harman and Kate Martinson for all of their hard work in achieving this fantastic milestone for the TOAST trial.