What does research say about the use of steroids, such as prednisolone, for treating sore throat?

Steroids for Sore Throat: Evidence-Based Recommendations

Corticosteroids are not routinely recommended for treatment of sore throat but can be considered in adult patients with severe presentations (3-4 Centor criteria) in conjunction with antibiotic therapy. 1

Evidence Summary

Efficacy of Corticosteroids

• A systematic review and meta-analysis showed that adults with severe or high Centor scoring sore throat (3-4 criteria) may benefit from a single dose of corticosteroids when used alongside antibiotic therapy 1
• Corticosteroids can increase the likelihood of complete pain resolution at 24 hours by 2.4 times and at 48 hours by 1.5 times compared to placebo (high-certainty evidence) 2
• The number needed to treat is approximately 5 patients to prevent one person from continuing to experience pain at 24 hours 2
• Corticosteroids can reduce mean time to onset of pain relief by approximately 6 hours and time to complete resolution by 11.6 hours 2

Patient Selection

• Benefits are most pronounced in adult patients with severe presentations of sore throat (3-4 Centor criteria) 1
• No significant benefit has been demonstrated in children with sore throat 1, 2
• The effect of steroids appears smaller when administered orally compared to other routes 1

Limitations and Considerations

• Most studies evaluated corticosteroids as an adjunct to antibiotic therapy, not as standalone treatment 2, 3
• The effect of steroids might be considerably smaller in typical primary care populations where most patients do not have severe sore throat 1
• Studies were not sufficiently powered to detect adverse effects of short courses of oral corticosteroids 1
• The reporting of adverse events in studies has been poor, limiting comprehensive safety assessment 2

Clinical Algorithm for Steroid Use in Sore Throat

Step 1: Assess Severity

• Determine Centor score (presence of tonsillar exudate, tender anterior cervical lymphadenopathy, absence of cough, history of fever) 1
• Scores of 3-4 indicate more severe presentation 1

Step 2: Treatment Decision

• For mild cases (Centor 0-2):

  • Recommend analgesics (ibuprofen or paracetamol) 1
  • Corticosteroids are not recommended 1

• For severe cases (Centor 3-4) in adults:

  • Consider a single dose of corticosteroids in conjunction with appropriate antibiotic therapy 1
  • Discuss potential modest benefits against possible side effects 1, 2

Step 3: First-line Treatments

• Regardless of steroid use decision, recommend ibuprofen or paracetamol for symptom relief 1
• Avoid zinc gluconate as it is not recommended for sore throat treatment 1

Common Pitfalls and Caveats

• Corticosteroids should not be used routinely for all cases of sore throat 1
• Avoid prescribing steroids for hoarseness or dysphonia without proper evaluation, as there is a preponderance of harm over benefit 1
• Do not use steroids as standalone therapy without antibiotics in severe cases, as current evidence primarily supports their use as adjunctive therapy 2, 3
• Be aware that most research on steroid use for sore throat has been conducted in conjunction with antibiotic therapy, limiting conclusions about steroid use alone 2, 3
• Short-term steroid use may have adverse effects that were not adequately captured in existing studies 1, 2

In conclusion, while corticosteroids may provide modest symptom relief for adults with severe sore throat when used alongside antibiotics, they should not be routinely prescribed for all cases of sore throat. The decision to use steroids should be reserved for adult patients with severe presentations (Centor criteria 3-4) after weighing potential benefits against possible adverse effects.