Is there evidence for the use of prednisolone in the management of sore throat?

Corticosteroids for Sore Throat Management

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

Evidence for Corticosteroid Use

The evidence demonstrates that single low-dose corticosteroids (typically oral dexamethasone ≤10 mg) provide modest symptomatic benefit when added to standard care:

• Patients receiving corticosteroids are 2.4 times more likely to experience complete pain resolution at 24 hours (risk difference 12.4%; high-certainty evidence), meaning 5 patients need treatment to prevent one person from continuing to experience pain. 2

• At 48 hours, corticosteroids increase the likelihood of pain resolution by 1.5 times (risk difference 18.3%; high-certainty evidence). 2

• Mean time to onset of pain relief is accelerated by 4.8 hours, and complete pain resolution occurs 11.6 hours earlier compared to placebo (moderate-certainty evidence). 2, 3

• Absolute pain reduction at 24 hours is 10.6% greater on visual analogue scales (moderate-certainty evidence). 2

Clinical Application Algorithm

For patients with 0-2 Centor criteria:

• Do not use corticosteroids 1
• Recommend ibuprofen or paracetamol for symptomatic relief 1, 4

For patients with 3-4 Centor criteria (severe presentation):

• Consider corticosteroids only in conjunction with antibiotic therapy 1, 4
• Use single low-dose oral dexamethasone (maximum 10 mg) 2
• Discuss modest benefits versus risks with the patient 1

Important Caveats and Limitations

The guideline recommendation is conservative despite positive research evidence. While systematic reviews and meta-analyses demonstrate clear symptomatic benefit 2, 3, the European Society for Clinical Microbiology and Infectious Diseases guideline explicitly states corticosteroids are "not routinely recommended" and should only be considered in severe adult presentations when combined with antibiotics. 1

Safety data is reassuring but limited:

• No increase in serious adverse events was reported in included trials 2, 3
• However, adverse event reporting was poor across studies 2
• Potential risks of cumulative doses in patients with recurrent sore throat episodes have not been assessed 2

Evidence gaps exist for children:

• Only 2 of 9 trials included pediatric patients 3
• The small number of studies increases uncertainty when applying results to children 3

What NOT to Use

• Zinc gluconate is not recommended for sore throat treatment (B-2 evidence). 1, 5
• Herbal treatments and acupuncture have inconsistent evidence and should not be recommended (C-1 to C-3 evidence). 1, 5

First-Line Treatment Remains Analgesics

Ibuprofen or paracetamol are the recommended first-line treatments for acute sore throat symptoms, with both showing equivalent efficacy and safety for short-term use. 1, 5, 4 Ibuprofen demonstrates slightly better pain relief efficacy than paracetamol. 1, 4