Steroid Injection in Strep Throat
Corticosteroids are not recommended as standard treatment for strep throat, though they may be considered in select adult patients with severe presentations (Centor score 3-4) as adjunctive therapy alongside antibiotics, but the benefit is minimal and they should not be used routinely. 1, 2
Primary Recommendation Against Routine Use
The Infectious Diseases Society of America explicitly states that adjunctive therapy with corticosteroids is not recommended for group A streptococcal pharyngitis 1. This recommendation is based on several key considerations:
- Minimal clinical benefit: While corticosteroids do decrease duration and severity of symptoms, the actual reduction in pain duration is only approximately 5 hours 1
- Self-limited disease: GAS pharyngitis resolves on its own with appropriate antibiotic therapy 1
- Effective alternatives exist: Systemic analgesics like NSAIDs and acetaminophen are effective for symptom management without steroid risks 1
- Potential for adverse effects: Long-term safety data are lacking, and studies were not adequately powered to detect adverse effects of short courses 1, 2
Limited Exception for Severe Cases in Adults
The American College of Physicians suggests corticosteroids can be considered (but are not routinely recommended) in adult patients with severe presentations meeting 3-4 Centor criteria when used alongside antibiotic therapy 2. Key points about this exception:
- Adults only: No significant benefit has been demonstrated in children with sore throat 2
- Severe cases only: Benefits are most pronounced in adults with Centor scores of 3-4 (fever, tonsillar exudates, tender anterior cervical lymphadenopathy, absence of cough) 2
- Single dose: When used, a single dose is recommended rather than a prolonged course 2
- Route matters: The effect appears smaller when administered orally compared to other routes 2
Preferred Treatment Approach
The standard treatment for strep throat should focus on appropriate antibiotics plus analgesics, not steroids:
- First-line antibiotic: Penicillin or amoxicillin for 10 days 1, 3
- Analgesics: NSAIDs (such as ibuprofen) or acetaminophen for moderate to severe symptoms or high fever 1, 4
- Avoid aspirin in children: Due to risk of Reye syndrome 1, 4
Clinical Pitfalls to Avoid
- Do not use steroids routinely: The effect is considerably smaller in typical primary care populations where most patients do not have severe sore throat 2
- Do not prescribe steroids for hoarseness/dysphonia: There is a preponderance of harm over benefit in these presentations 2
- Discuss risks vs. benefits: If considering steroids in severe adult cases, discuss the modest benefits against possible side effects 2
- Always provide analgesics: Regardless of steroid decision, recommend ibuprofen or paracetamol for symptom relief 2