From the Guidelines
Dexamethasone is not recommended as a routine treatment for acute pharyngitis in pediatric patients. The first-line treatment for bacterial pharyngitis (strep throat) is antibiotics, typically penicillin or amoxicillin, with dosing based on the child's weight, as recommended by the Infectious Diseases Society of America 1. For viral pharyngitis, which is more common, supportive care with adequate hydration, rest, and over-the-counter pain relievers like acetaminophen or ibuprofen is appropriate.
While dexamethasone has been studied for its anti-inflammatory effects in reducing throat pain, the evidence for its routine use in pediatric pharyngitis is limited and it is not part of standard treatment guidelines, as stated in the 2012 update by the Infectious Diseases Society of America 1. Dexamethasone may mask symptoms without addressing the underlying cause and carries potential side effects including immune suppression, metabolic effects, and mood changes.
Some key points to consider in the management of acute pharyngitis include:
- Identifying the cause of pharyngitis to provide appropriate targeted therapy
- Using antibiotics only when a bacterial cause is confirmed, to prevent unnecessary exposure to antimicrobial therapy and reduce the risk of antimicrobial resistance
- Considering adjunctive therapy with an analgesic or antipyretic, such as acetaminophen or ibuprofen, to treat moderate to severe symptoms or control a high fever, as recommended by the American Family Physician 1
- Avoiding the use of aspirin in children due to the risk of Reye syndrome, as warned by the Infectious Diseases Society of America 1
If a child has severe symptoms or difficulty swallowing that significantly impacts hydration, they should be evaluated by a healthcare provider who can determine the appropriate treatment based on the specific clinical situation. The focus should remain on identifying the cause of pharyngitis and providing appropriate targeted therapy rather than symptom management with corticosteroids.
From the Research
Dexamethasone for Acute Pharyngitis in Pediatric Patients
- The use of dexamethasone as an adjuvant therapy for acute pharyngitis has been studied in various settings, including its effectiveness in reducing pharyngeal inflammatory pain 2.
- A study published in 2002 found that a single dose of dexamethasone, either intramuscular or oral, significantly reduced pain in patients with acute pharyngitis compared to placebo 2.
- Another study from 2008 demonstrated that an 8-mg single dose of intramuscular dexamethasone provided faster onset of pain relief and shorter duration of pain in patients with acute exudative pharyngitis compared to placebo 3.
- In the context of pediatric patients, a study from 2012 suggested that a single dose of oral dexamethasone (0.6 mg/kg, maximum 10 mg) 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 4.
- Current recommendations for the management of acute pharyngitis in children and adults vary, with some guidelines supporting antibiotic treatment to prevent acute rheumatic fever and others recommending a more tailored approach based on individual risk 5.
Key Findings
- Dexamethasone can provide significant relief of pain in patients with acute pharyngitis 2, 3.
- The use of dexamethasone as an adjuvant therapy may be beneficial in reducing the duration of pain and improving symptoms in pediatric patients with acute pharyngitis 4.
- Further studies are needed to determine the optimal management strategy for acute pharyngitis in children and to address the divergences in current guidelines 5.