Steroid Shots Are Not Recommended for Viral Pharyngitis
No steroid injection (or any systemic corticosteroid) should be given for viral pharyngitis in healthy patients, as major guidelines explicitly recommend against this practice. 1
Guideline Recommendations Against Corticosteroids
The Infectious Diseases Society of America explicitly recommends against using corticosteroids as adjunctive therapy for pharyngitis, including viral pharyngitis (weak recommendation, moderate quality evidence). 1
French guidelines similarly state that no data confirm the benefit of systemic corticosteroids in the treatment of acute pharyngitis. 2
The American Academy of Family Physicians reinforces that steroids are not recommended for symptomatic treatment of pharyngitis. 3
Why Guidelines Recommend Against Steroids
The rationale for avoiding corticosteroids is clear:
While research shows corticosteroids can reduce pain duration, the actual benefit is minimal—approximately 5 hours of pain reduction—which does not justify the potential adverse effects of systemic steroid administration. 1
Viral pharyngitis is self-limited, and the modest symptomatic benefit does not outweigh the risks associated with systemic corticosteroid use. 1
The evidence quality supporting corticosteroid use is insufficient to overcome concerns about adverse effects in routine clinical practice. 4
Recommended Symptomatic Management Instead
Use NSAIDs or acetaminophen as first-line therapy for pain and fever control:
NSAIDs (such as ibuprofen) are more effective than acetaminophen for fever and pain control in pharyngitis and should be the preferred analgesic. 5, 1
Acetaminophen provides significant pain relief compared to placebo and is an acceptable alternative. 5, 1
Avoid aspirin in children due to the risk of Reye syndrome. 5, 1
Topical therapies like lozenges, sprays containing local anesthetics (benzocaine, lidocaine), or warm salt water gargles may provide temporary additional relief. 1
Common Pitfalls to Avoid
Do not prescribe steroids simply because the patient requests faster symptom relief—the minimal benefit (5 hours) does not justify systemic steroid exposure. 1
Do not confuse viral pharyngitis with streptococcal pharyngitis—even in confirmed GAS pharyngitis, corticosteroids are not recommended. 1
Do not use antibiotics for viral pharyngitis—they are ineffective and contribute to resistance. 2, 5