From the Guidelines
Oral steroids are not recommended for viral pharyngitis. Viral pharyngitis is a self-limiting condition caused by viruses that typically resolves on its own within 7-10 days without specific treatment. Steroids, which suppress the immune system, are not appropriate for viral infections and may potentially worsen outcomes by hampering the body's natural defense against the virus. According to a study published in the Clinical Infectious Diseases journal 1, the use of corticosteroids in the treatment of pharyngitis is not recommended due to the potential for adverse effects and the self-limited nature of the illness.
Instead, treatment should focus on symptom management with over-the-counter pain relievers like acetaminophen or ibuprofen, as supported by studies showing their effectiveness in reducing fever and pain in patients with pharyngitis 1. Other measures such as throat lozenges, warm salt water gargles, and adequate hydration and rest can also help alleviate symptoms. If symptoms are severe or persist beyond 10 days, or if you develop high fever, difficulty breathing or swallowing, or severe pain, you should consult a healthcare provider to rule out bacterial infection or other complications that might require different treatment approaches.
Some key points to consider in the management of viral pharyngitis include:
- The use of NSAIDs such as ibuprofen for symptom relief, as they have been shown to be effective in reducing fever and pain in patients with pharyngitis 1
- The avoidance of aspirin in children due to the risk of Reye syndrome, as recommended by the Clinical Infectious Diseases journal study 1
- The importance of adequate hydration and rest in helping the body recover from the infection
- The need to seek medical attention if symptoms worsen or persist, to rule out complications or bacterial infections that may require antibiotic treatment.
From the Research
Oral Steroids for Viral Pharyngitis
- The use of oral steroids as an adjuvant therapy for acute pharyngitis has been studied in several trials 2, 3, 4, 5.
- A randomised controlled trial found that short-acting oral steroid therapy with prednisone was effective in shortening throat pain duration in acute pharyngitis 2.
- A systematic review of 8 randomised controlled trials found that steroids were effective in relieving pain in acute pharyngitis, with no serious adverse side effects reported 3.
- A prospective, randomised, double-blinded, placebo-controlled study found that a single dose of dexamethasone was effective in reducing pharyngeal inflammatory pain in patients with acute pharyngitis 4.
- Another study found that a single dose of oral dexamethasone led to significantly faster onset of pain relief and shorter suffering in children with severe or exudative group A β-hemolytic streptococcus-positive acute pharyngitis 5.
Comparison of Oral Steroids
- The studies compared different oral steroids, including prednisone 2 and dexamethasone 4, 5.
- Dexamethasone was found to be effective in reducing pain in acute pharyngitis, with a single dose providing significant relief 4, 5.
- Prednisone was also found to be effective in shortening throat pain duration in acute pharyngitis 2.
Limitations and Considerations
- The studies had some limitations, including the use of different steroids and dosages, and the lack of control for analgesic medication use 3.
- The benefits of steroid use must be balanced with possible adverse drug effects, and further studies are needed to establish the safety of steroids without antibiotic coverage 3.
- The diagnosis and treatment of pharyngitis should be based on a thorough history and clinical findings, with rapid antigen detection tests and throat cultures used to identify the inciting organism 6.