Introduction
One of the most common presenting complaints among patients in
outpatient care clinics is sore throat
[1], resulting in approximately 5% of
all outpatients visits [2]. Bacterial-
or viral-induced acute pharyngotonsillitis is the cause of more than
75% of sore throats [3]. Several
national guidelines recommend pain relief with non-steroidal
anti-inflammatory drugs (NSAIDs) or acetaminophen as the main management
strategy [4-6]. However, these drugs
provide insufficient pain relief in many cases. Although less than 10%
of adult pharyngotonsillitis are caused by bacteria and the risk of
suppurative complications is low, primary care physicians usually
prescribe antibiotics, despite their limited symptomatic benefit
[7-9].
The need to reduce pain relief consumption has led to a focus on
alternative treatment with corticosteroids
[10]. Corticosteroids are potent
anti-inflammatory mediators. Results of several randomized control
trials have suggested that short courses of corticosteroid therapy
provide symptomatic relief benefits to sore throat patients, with no
safety concerns [11-13]. A systemic
review revealed that patients treated with a single steroid dose were
more likely to experience complete sore throat resolution within 24
hours, in a setting of antibiotic use in both the steroid and placebo
groups [14]. Recently, another
primary care randomized trial showed that oral corticosteroid
administration unaccompanied by immediate antibiotic use increased the
proportion of patients with sore throat resolution within 48 hours
[15]. Despite this new potential
practice changing evidence, corticosteroid prescribing remains uncommon
and the previous conventional treatments such as antibiotics, remain the
norm [16].
This study confirmed the effectiveness and safety of adjuvant
corticosteroid treatment with standard care and provided evidence for
the wide application of this new strategy in primary care, by
investigating treatment outcomes in sore throat adults 18 years or older
and the prognostic factors associated with increased symptom resolution.