Acute pharyngitis or tonsillitis is characterized by the inflammation of posterior pharynx and tonsils is a pretty common complaint that we might see with patients. Some are caused by several viruses and others are from different strains of bacteria. Nevertheless, patients’ main complaints are the symptom of pain and discomfort. After reading the article, Effect of Oral Dexamethasone Without Immediate Antibiotics vs Placebo on Acute Sore Throat in Adults A Randomized Clinical Trial it shows several limitations.1 It doesn’t give much information regarding treatment of specific diagnosis. Those given dexamethasone will show no significant difference in symptoms resolution but have more pain relief after 48 hours. Out of 565 randomized participants, 288 were given dexamethasone and 277 received a placebo. After 24 hours, not much difference between the two groups. Even with antibiotics versus delay antibiotic treatment, the results were pretty similar. After 48 hours, 35.4% of patients that received dexamethasone over all experienced resolution of discomfort where 27.7% of the placebo weren’t as successful. Several questions need to be asked and answered. Where can I find the best available evidence to support the patient’s complaint? As I tend to use Up-To-Date for a quick search and reference. After reading this article, should I change the way I practice? Well, that depends. Does this study show the exact or very similar complaints to mine? Will my patients benefit from oral steroids for his/her complaint? Sure, some can given the right situation but oral steroids is only to relief the symptom of pain. It doesn’t treat the problem. Viral pharyngitis will have to run its course of symptoms. Bacterial pharyngitis will need antibiotics. We all know that oral steroids will not cure bacterial infections. Are there other ways of treatment that is just as effective? What are the clinical guidelines for acute sore throat treatment?2 How about the patient’s preference? It’s a laundry list of questions to make a safe diagnosis with the most effective, less invasive with cost conscience answer. From someone who has treated thousands of patients complaining of sore throat, oral steroids would not be my go-to treatment to subside any discomfort from the complaint. Whatever happened to Motrin or Tylenol?3 Studies has also shown that acute sore throat should be treat with self-medication. Although this article was well written, the use of oral corticosteroid has not convinced me to routinely treat acute sore throat with anything but Motrin or Tylenol for pain relief. Oral steroids like dexamethasone doesn’t take in effect until after 48 hours which means it doesn’t reduce the time off for work or school. So, for me, unless given the right patient with severe sore throat and diff swallowing, over the counter analgesic with supportive care is the way I will continue to practice.
