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.