We have some concerns regarding the proposal to treat acute pharyngitis with high dose oral steroids.1
Kiderman et al suggest that steroids may reduce short-term pain in a selected group of patients with sore throat presenting in primary care.1 The selection criteria for their study are similar to the Centor criteria and thus likely to select a group with higher probability of positive throat swab, better response to antibiotics and higher complication rate.2 Antibiotics were administered at the treating physicians recommendation and all those with positive swabs were subsequently treated. The authors fail to account for this potential confounder in their analysis. The study had insufficient power to detect differences in relapse rates and more importantly complications. Quinsy, for instance, would be expected in 1:60 cases with the Centor criteria2 and there may be rare complications resulting from the steroid treatment.3 The authors' conclusion that high dose steroids are safe in this context is unjustified. Moreover, this group have a predominantly self-limiting illness and treatment with steroids is likely to parallel antibiotic treatment in producing a medicalising effect and increasing reconsultation rates.4 Any potential benefit in short-term symptom relief must be balanced against unknown harm and altered illness behaviour.
More and better evidence of safety and effectiveness is needed before prescribing steroids can be advocated in acute pharyngitis.