From the Guidelines
Prednisolone can be considered for adult patients with severe sore throat presentations, such as those with 3-4 Centor criteria. This is based on a systematic review and meta-analysis that showed adults with severe or high Centor scoring sore throat would benefit from a single dose of corticosteroids in conjunction with antibiotic therapy 1. The use of corticosteroids in conjunction with antibiotic therapy is not routinely recommended for treatment of sore throat, but it can be considered in adult patients with severe presentations.
- Key points to consider when prescribing prednisolone for sore throat include:
- The patient should have a severe presentation, such as 3-4 Centor criteria
- The patient should be an adult, as there is no evidence of significant benefit in children 1
- The use of corticosteroids should be in conjunction with antibiotic therapy
- The effect of steroids may be smaller when administered by oral route, and the studies included in the systematic review were not sufficiently powered to detect adverse effects of short courses of oral corticosteroids 1
- It is essential to weigh the potential benefits and risks of prednisolone treatment for sore throat, and to consult a healthcare provider before starting treatment, especially if the patient has conditions like diabetes, high blood pressure, or a history of stomach ulcers.
- The dosage and duration of prednisolone treatment for sore throat should be determined on a case-by-case basis, taking into account the severity of the presentation and the patient's individual needs.
From the Research
Sore Throat and Prednisolone
- Sore throat is a common condition that can be caused by viral, bacterial, or fungal infections 2.
- Corticosteroids, such as prednisolone, may be used to reduce inflammation and improve symptoms of sore throat 3, 4, 5, 6.
Effectiveness of Corticosteroids
- Studies have shown that corticosteroids can increase the likelihood of complete resolution of pain at 24 and 48 hours 3, 4.
- Corticosteroids can also reduce the mean time to onset of pain relief and the mean time to complete resolution of pain 3, 4.
- The use of corticosteroids has been found to be effective in relieving pain in acute pharyngitis, with no serious adverse side effects reported 5, 6.
Use of Prednisolone
- A randomised controlled trial found that short-acting oral therapy with prednisone was more effective than placebo in alleviating suffering from acute pharyngitis in adults 5.
- Another study found that steroids, including prednisone, were effective in relieving pain in acute pharyngitis, although the benefits need to be balanced with possible adverse drug effects 6.
Treatment Approach
- A thorough history is key to diagnosing pharyngitis, and rapid antigen detection tests should be reserved for concerns about antibiotic initiation 2.
- Physicians should exercise restraint in antibiotic initiation for pharyngitis, as restraint does not delay recovery or increase the risk of S pyogenes infections 2.
- Corticosteroids, such as prednisolone, may be considered as an adjuvant therapy for acute pharyngitis, although further studies are needed to establish their safety and benefits 3, 4, 6.