When is Decadron (dexamethasone) considered for a sore throat?

Use of Dexamethasone for Sore Throat

Dexamethasone should be considered only in adult patients with severe sore throat (Centor score 3-4) when used in conjunction with antibiotic therapy, but is not routinely recommended for most cases of acute pharyngitis. 1, 2

Patient Selection Criteria

Adults with Severe Presentations

• Reserve corticosteroids for adults meeting 3-4 Centor criteria (fever >38°C, tonsillar exudate, tender anterior cervical lymphadenopathy, absence of cough) when antibiotics are also indicated 1, 2
• A single dose of oral dexamethasone (10 mg) in conjunction with antibiotics provides modest benefit in this population 1, 2
• The effect is considerably smaller in typical primary care populations where most patients have mild-to-moderate sore throat 1, 2

Evidence for Benefit

• Adults with severe/high Centor scoring sore throat showed faster symptom resolution when given corticosteroids alongside antibiotics 1, 2
• In the most recent high-quality trial, dexamethasone showed no significant benefit at 24 hours (22.6% vs 17.7% complete resolution, P=0.14), but did show benefit at 48 hours (35.4% vs 27.1%, P=0.03) 3
• The oral route appears less effective than other administration routes 1, 2

Populations Where Dexamethasone Should NOT Be Used

Children

• No significant benefit has been demonstrated in children with sore throat 1, 2
• Despite some pediatric studies showing faster pain relief with dexamethasone 0.6 mg/kg (maximum 10 mg) 4, 5, guidelines do not support routine use in children 1, 2

Mild-to-Moderate Cases (Centor 0-2)

• Do not use corticosteroids in patients with less severe presentations 1, 2
• These patients should receive only symptomatic treatment with ibuprofen or paracetamol 1, 2

Dosing When Indicated

• Single dose of oral dexamethasone 10 mg for adults with severe presentations 3, 2
• Must be given in conjunction with appropriate antibiotic therapy (penicillin V for 10 days if treating streptococcal pharyngitis) 1

Important Caveats

Safety Concerns

• Studies were not adequately powered to detect adverse effects of short-course oral corticosteroids 1, 2
• The modest benefits must be weighed against potential side effects 2
• Never use steroids for hoarseness or dysphonia without proper evaluation, as there is preponderance of harm over benefit 2

Standard Symptomatic Treatment

• All patients should receive ibuprofen or paracetamol for pain relief regardless of steroid use decision 1, 2
• These analgesics are more effective than placebo and are the first-line symptomatic treatment 1

What NOT to Use

• Zinc gluconate is not recommended for sore throat treatment 1, 2
• Herbal treatments and acupuncture have inconsistent evidence 1

Clinical Algorithm

1. Assess severity using Centor criteria (fever, exudate, lymphadenopathy, no cough) 1
2. If Centor 0-2: Symptomatic treatment only with ibuprofen or paracetamol; no antibiotics or steroids 1
3. If Centor 3-4 in adults: Consider antibiotics (penicillin V × 10 days) AND may add single dose dexamethasone 10 mg after discussing modest benefits vs. risks 1, 2, 3
4. If pediatric patient: Do not use corticosteroids regardless of severity 1, 2