Results of TOAST trial: Oral Dexamethasone to Treat Acute Sore Throat?
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
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
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
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
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