BACKGROUND AND PURPOSE: 

• A previous systematic review determined that the use of oral corticosteroids was associated with complete resolution of an acute sore throat within one day 
  • However, antibiotics were also used in both steroid and placebo groups   
• In the Treatment Options Without Antibiotics for Sore Throat (TOAST) trial, Hayward et al. (JAMA, 2017) examined the effectiveness of dexamethasone (DEX), in the absence of antibiotic treatment for acute sore throat 

MEHODS: 

• Double-blind, placebo-controlled randomized trial 
• General Practice clinics 
• 28 day follow up  
• Patients were given either: 
  • Single oral dose of 10 mg dexamethasone (DEX)  
  • Identical appearing placebo  
• Primary outcome was proportion of patients experiencing complete resolution of symptoms with 24 hours 
• Secondary outcomes were complete resolution in 48 hours, duration of symptoms, visual analog symptom scale, health care attendance, days missed from work or school, consumption of delayed antibiotics or over-the-counter medication, adverse events 

RESULTS: 

• 565 eligible participants were randomized 
  • 75.2% were women  
  • 288 received DEX and 277 received placebo  
• 24 hours: No significant difference between groups in resolution of symptoms  
  • 22.6% of DEX group and 17.7% of placebo group had complete symptom resolution at 24 hours 
• 48 hours: When comparing DEX to placebo group 
  • Increased complete resolution of symptoms 
  • 35.4% of DEX group and 27.1% of placebo group  
  • Relative risk (RR) 1.31 (95% CI, 1.02-1.68; P = .03) 
• No significant difference for the other secondary outcomes 
• Similar effects noted for patients who did not receive antibiotic prescription compared to those offered delayed antibiotic prescriptions 

CONCLUSION: 

• A single dose of oral DEX may improve the resolution of symptoms of acute sore throat after 48 hours in the absence of antibiotic treatment  
•  Average of 12 patients would need to be treated for 1 additional patient to experience symptom resolution 
• May not apply to severe sore throat as those more likely to receive antibiotics 

Learn More – Primary Sources:  

Effect of Oral Dexamethasone Without Immediate Antibiotics vs Placebo on Acute Sore Throat in Adults

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