EFFICACY
OF SINGLE-DOSE DEXAMETHASONE AS ADJUVANT THERAPY FOR ACUTE PHARYNGITIS.
Wei JL,
et al. Laryngoscope 2002 Jan;112(1):87-93
HYPOTHESIS:
Pharyngeal inflammatory pain is reduced by a single dose of dexamethasone.
STUDY
DESIGN: Prospective, randomized, double-blinded, placebo-controlled study.
METHODS:
From August 1998 to July 2000, a total of 118 patients were enrolled. We
compared placebo (n = 37), a 10-mg single dose of intramuscular injection of
dexamethasone (n = 39), and a 10-mg single dose of oral dexamethasone (n = 42).
All patients were given oral antibiotics and had bacterial throat cultures.
RESULTS:
Complete telephone follow-up 12 hours after treatment was available in 111
patients, and 24-hour follow-up data were available in 116. The change in pain
visual analogue scale scores (pretreatment score minus 12-h follow-up score)
reported by patients who were given either intramuscular (median score, 4; mean
score +/- SD, 4.2 +/- 2.3) or oral dexamethasone (median score, 3; mean score
+/- SD, 3.8 +/- 2.3) was significantly greater than that of the patients who
were given placebo (median score, 2; mean score +/- SD, 2.1 +/- 2.0) (P
<.001 and P =.002, respectively). This difference in improvement was also
evident when the percentage of change was compared in the three treatment arms
at 12-hour and 24-hour follow-up. Patients who were given dexamethasone had the
onset of pain relief a median of 4 hours earlier than those who were given oral
and intramuscular placebo (P =.029). Statistically significant differences
among the three treatment arms were confirmed when a bacterial pathogen was
identified (n = 47) but not in a subset that did not have a pathogen
identified.
CONCLUSIONS:
Single-dose dexamethasone appears to be a safe, effective, and inexpensive
adjunctive treatment for acute pharyngitis in patients 15 years of age and
older. Patients treated with intramuscular or oral dexamethasone had
significant relief of pain (relative to baseline) compared with patients who
were given placebo. Identification of a bacterial pathogen had a significant
impact on the response to dexamethasone.
DEXAMETHASONE
AS ADJUVANT THERAPY FOR SEVERE ACUTE PHARYNGITIS.
O'Brien
JF, Meade JL, Falk JL. Ann Emerg Med 1993 Feb;22(2):212-5
STUDY
OBJECTIVE: To determine the efficacy of dexamethasone as adjuvant therapy to
improve pain relief in patients with severe, acute exudative pharyngitis.
DESIGN:
Prospective, randomized, double-blinded, placebo-controlled clinical trial.
SETTING:
Large, urban community hospital emergency department with an emergency medicine
residency program.
TYPE OF
PARTICIPANTS: Patients aged 12 to 65 years old with exudative pharyngitis and
severe dysphagia/odynophagia. Patients with cancer, AIDS, diabetes mellitus,
recent steroid use, pregnancy, or suspicion of peritonsillar abscess were
excluded.
INTERVENTIONS:
All patients received oral penicillin (500 mg Pen VK) or erythromycin (333 mg
base) three times daily for ten days in addition to either 10 mg single-dose
dexamethasone or saline placebo IM injection.
MEASUREMENTS
AND RESULTS: Fifty-eight patients graded their initial degree of throat pain on
a visual-analog scale that was 15 cm long and scored from 0 to 3.0 in 0.5-cm
increments. Follow-up was obtained on 51 patients to determine their condition
at 24 hours. At entry, there was no difference in age, weight, antibiotic
assignment, or initial pain score between groups. Improvement in pain score
(initial versus 24 hours) was 1.8 +/- 0.8 in the 26 patients of the dexamethasone
group and 1.2 +/- 0.9 in the 25 patients of the placebo group (P < .05).
Time to onset of pain relief was also faster in steroid-treated patients who
demonstrated relief beginning at 6.3 +/- 5.3 hours, compared with 12.4 +/- 8.5
hours in the placebo group (P < .01). Of the 26 patients evaluated at seven
days (13 in each group), time to complete lack of pain averaged 15.0 +/- 11.4
hours in the dexamethasone group and 35.4 +/- 17.9 hours in the placebo group
(P < .02). Complications attributable to dexamethasone were not observed.
CONCLUSION:
In patients with severe, acute exudative pharyngitis, single-injection
dexamethasone adjuvant compared with placebo resulted in statistically and
clinically significant improvement, as evidenced by more rapid onset and greater
degree of pain relief.
A
RANDOMIZED CLINICAL TRIAL OF ORAL VERSUS INTRAMUSCULAR DELIVERY OF STEROIDS IN
ACUTE EXUDATIVE PHARYNGITIS.
Marvez-Valls
EG, Stuckey A, Ernst AA. Acad Emerg Med 2002 Jan;9(1):9-14
Previous
study has shown that the use of intramuscular (IM) steroid leads to improved
symptoms in patients with group A beta-hemolytic streptococcus (GABHS).
OBJECTIVE:
To compare oral with IM steroids as an adjunct to antibiotic therapy in the
treatment of acute exudative pharyngitis. The null hypothesis was that there
would be no difference in effectiveness of oral versus IM steroids.
METHODS:
The study was a randomized, double-blind outpatient clinical trial. After
consent was obtained, each patient was asked to rate his or her pain on a 10-cm
numbered visual analog scale (VAS; 0-10). All of the patients received
injectable benzathine penicillin or, if allergic to penicillin, a ten-day
course of polyenteric-coated erythromycin. Each patient was randomized to
receive either injectable steroid plus oral placebo or injectable placebo plus
oral steroid. All medications were given in the emergency department. All
patients were contacted by telephone at 24 hours (first follow-up) and 48 hours
(second follow-up) by one of the study investigators and asked to rate their
pain based on another VAS. If their pain was not resolved by 48 hours, they
were called again daily for the third to seventh day after the initial visit.
The time to total resolution of the sore throat was documented. The main
outcome measures were time to complete relief of pain and VAS scores. Pain
medication was not controlled; however, use of pain medications and amounts
were recorded.
RESULTS:
A total of 78 patients were initially enrolled in the study. Eight patients
were excluded from the statistical analysis because of inability to follow up.
A total of 70 were entered, with 35 randomized to IM steroid plus oral placebo
and 35 to IM placebo plus oral steroid. There was no difference in pain scores
for the oral versus IM group at first follow-up (p = 0.13) and second follow-up
(p = 0.82), and in number of hours to relief of pain (p = 0.06). Using
repeated-measures analysis of variance, no difference in the effects of the two
medications over time was detected (p = 0.83).
CONCLUSIONS:
The results of this clinical trial suggest that oral steroid and IM steroid
provide similar levels of pain relief in acute exudative pharyngitis.