Are corticosteroids effective in decreasing pain when used as an adjunct to antibiotics in patients with acute
pharyngitis?
Bottom Line:
If these authors have identified all the relevant data, corticosteroids are associated with a reduction in pain severity and duration when used as an adjunct to antibiotics in patients with pharyngitis. Since the included studies have the potential for bias in favor of steroids, and since none of the studies assessed steroids as monotherapy, the jury is still out as to whether the use of steroids should become common practice. (LOE = 1a-)
Reference:
Korb K, Scherer M, Chenot JF. Steroids as adjuvant therapy for acute pharyngitis in ambulatory patients: a systematic review. Ann Fam Med 2010;8(1):58-63.
Study Design:
Meta-analysis (randomized controlled trials)
Funding:
Unknown/not stated
Setting:
Outpatient (any)
Synopsis:
These authors searched several databases to find randomized trials of adjuvant corticosteroids in patients with acute pharyngitis. Two authors independently determined study eligibility and resolved disagreements by consensus. They don't describe searching for unpublished data. The authors assessed the quality of the studies but don't report if the assessment was independently made by 2 or more reviewers. They wound up with 8 trials, 7 of which occurred in emergency departments. Five trials studied 413 adults, and 3 studied 393 children. The studies of adults were fairly different in their design and conduct, so the authors appropriately decided not to pool the data. In all these studies, patients also received antibiotics and other treatments for pain. All the studies reported decreases in pain intensity or duration, and the average time to complete pain relief was approximately 24 hours. The studies of children were similarly heterogeneous and also allowed co-interventions. All the studies of children also found a reduction in pain. The data on subgroups of patients with confirmed streptococcal infection were inconsistent. A key threat to the validity of the individual studies is the lack of intention-to-treat analysis in all but one of the included trials. The lack of intention-to-treat analysis has been shown to introduce bias in favor of interventions (in this case, it may make the steroids look better than they really are). Additionally, the authors did not look for unpublished studies and do not formally assess the possibility of publication bias. Since negative studies are more likely to remain unpublished, this oversight also has the potential to make steroids look more effective.
PMID: 20065280
Delivered as Daily POEM: 2010-03-16
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regards, taniafdi ^_^
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