What are the guidelines for using oral corticosteroids (steroids) with streptococcal pharyngitis (strep throat)?

From the Guidelines

Oral steroids are not recommended for the treatment of uncomplicated strep pharyngitis, and antibiotics such as penicillin or amoxicillin should be used as the primary treatment. The standard treatment for strep throat includes antibiotics, typically penicillin (such as penicillin V potassium 250-500 mg orally twice daily for 10 days) or amoxicillin (50 mg/kg once daily, maximum 1000 mg, for 10 days) 1. In penicillin-allergic patients, alternatives include cephalexin, clindamycin, azithromycin, or clarithromycin. However, some studies suggest that in cases of severe pain or significant tonsillar swelling that affects swallowing or breathing, a short course of oral corticosteroids may be considered as adjunctive therapy 1.

When considering the use of oral steroids, it is essential to weigh the potential benefits against the risks, particularly in patients with certain medical conditions. The potential side effects of oral steroids include increased blood glucose, mood changes, and increased appetite, though these are minimal with short courses. Steroids should be used cautiously in patients with diabetes, hypertension, or immunocompromised states, and are generally not recommended for pregnant women with strep throat unless clearly indicated.

Key points to consider when treating strep pharyngitis include:

• The importance of accurate diagnosis to prevent inappropriate antimicrobial therapy
• The use of antibiotics as the primary treatment for strep throat
• The potential role of adjunctive therapy, such as analgesics or antipyretics, in managing symptoms
• The need for caution when considering the use of oral steroids, particularly in patients with certain medical conditions. According to the most recent and highest quality study, adjunctive corticosteroids are not recommended in the treatment of group A streptococcal pharyngitis 1.

From the Research

Guidelines for Using Oral Steroids with Strep Pharyngitis

• There is no evidence to support the use of oral steroids as a treatment for strep pharyngitis 2.
• The use of steroids is not recommended for symptomatic treatment of strep pharyngitis 2.
• Antibiotics, such as penicillin and amoxicillin, are the recommended treatment for strep pharyngitis 3, 2, 4.
• The choice of antibiotic may depend on the patient's allergy status and the severity of the infection 3, 5, 6.

Diagnosis and Treatment of Strep Pharyngitis

• The diagnosis of strep pharyngitis is typically made using a throat culture or rapid antigen detection test 3, 2.
• The modified Centor score can be used to help physicians decide which patients need no testing, throat culture/rapid antigen detection testing, or empiric antibiotic therapy 3.
• Penicillin and amoxicillin are effective treatments for strep pharyngitis, with a recommended course of 10 days 3, 2, 4.
• First-generation cephalosporins are recommended for patients with nonanaphylactic allergies to penicillin 2.

Antibiotic Treatment Options

• Cephalosporins, macrolides, and carbacephem are alternative antibiotic treatment options for strep pharyngitis, but the evidence for their effectiveness is limited 5, 6.
• Azithromycin may be an option for patients who are allergic to penicillin, but the evidence for its effectiveness is limited 5, 6.
• The choice of antibiotic should be based on the patient's individual needs and the severity of the infection 3, 5, 6.