Can steroids help with an inflamed throat and tonsils?

Steroids for Inflamed Throat and Tonsils

For adults with severe sore throat (Centor score 3-4), a single dose of corticosteroid alongside antibiotic therapy provides modest benefit—reducing pain duration by approximately 5 hours and increasing complete pain resolution at 24 hours—but this should be weighed against potential adverse effects, and steroids are NOT recommended for routine use in all sore throat cases. 1, 2

When to Consider Steroids

Adults with Severe Presentations

• Use steroids only in adults with severe sore throat (3-4 Centor criteria) in conjunction with appropriate antibiotic therapy 1, 2
• Centor criteria include: fever, tonsillar exudates, tender anterior cervical lymphadenopathy, and absence of cough 1
• The benefit is modest: approximately 5 hours reduction in pain duration 2
• Complete pain resolution at 24 hours is 2.4 times more likely with steroids (RR 2.4,95% CI 1.29-4.47) 3
• At 48 hours, complete resolution is 1.5 times more likely (RR 1.50,95% CI 1.27-1.76) 3
• Five patients need treatment to prevent one person from continuing to experience pain at 24 hours 3

Children

• No significant benefit has been demonstrated in children with sore throat 1
• Steroids should not be routinely used in pediatric sore throat cases 1

Dosing and Administration

• Use a single dose approach when steroids are indicated 1, 2
• Dexamethasone is commonly used (0.5 mg/kg in perioperative settings, though lower doses may be equally effective) 4
• Oral administration appears less effective than other routes 1
• All included trials used steroids in combination with antibiotics, not as standalone therapy 3, 5

First-Line Pain Management Instead

Prescribe ibuprofen or acetaminophen as first-line adjunctive therapy alongside appropriate antibiotics when indicated 2

• NSAIDs like ibuprofen demonstrate significant benefits in reducing fever and pain 2
• This represents a strong recommendation with high-quality evidence 2
• Topical agents containing local anesthetics may provide temporary relief 2

Important Safety Concerns

Documented Risks

• Short- and long-term steroid use carries risks including hypertension, cardiovascular disease, osteoporosis, impaired wound healing, infections, mood disorders, and diabetes 2
• Studies were not sufficiently powered to detect adverse effects of short courses of oral corticosteroids 1
• Reporting of adverse events in existing trials was poor 3

Specific Contraindications

• The Infectious Diseases Society of America explicitly recommends AGAINST corticosteroids as adjunctive therapy for Group A Streptococcal pharyngitis (weak recommendation, moderate quality evidence) 2
• Avoid prescribing steroids for hoarseness or dysphonia without proper evaluation, as there is a preponderance of harm over benefit 1

Clinical Decision Algorithm

1. Assess severity using Centor criteria (fever, tonsillar exudates, tender anterior cervical nodes, no cough) 1

2. For Centor 0-2 (mild-moderate):

   • Do NOT use steroids 1, 2
   • Prescribe ibuprofen or acetaminophen for symptom relief 2
   • Consider antibiotics only if bacterial infection is confirmed 1

3. For Centor 3-4 (severe) in adults:

   • Consider single-dose corticosteroid WITH antibiotic therapy 1, 2
   • Discuss modest benefits (5-hour pain reduction) against possible side effects 1, 2
   • Always prescribe ibuprofen or acetaminophen regardless of steroid decision 1, 2

4. For children (any severity):

   • Do NOT use steroids 1
   • Focus on ibuprofen or acetaminophen for pain control 2

Common Pitfalls to Avoid

• Do not use steroids routinely for all sore throat cases—the effect is considerably smaller in typical primary care populations where most patients do not have severe presentations 1
• Do not prescribe steroids without concurrent antibiotic therapy when indicated—no trials have assessed corticosteroids as standalone treatment 3, 5
• Do not use steroids in children with sore throat—no benefit has been demonstrated 1
• Do not prescribe zinc gluconate—it is not recommended for sore throat treatment 1
• Avoid multiple or prolonged courses—the recommendation is for a single dose only 1, 2

Additional Context

The benefit of steroids is most pronounced when pain is assessed at 24 hours, with mean time to complete pain resolution reduced by approximately 11.6 hours 3. However, pain reduction by visual analogue scale at 24 hours shows only an additional 10.6% improvement 3. No differences in recurrence/relapse rates or days missed from work or school have been reported 3.