The Role of Betamethasone in the Treatment of Acute Exudative Pharyngitis

Abstract

Abstract. Objective: To compare betamethasone with placebo as an adjuvant to antibiotic therapy in the treatment of acute exudative pharyngitis. Methods: The study was a randomized, doubled-blind, placebo-controlled, single-center, parallel, 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. If allergic to penicillin, they were started on a 10-day course of polyenteric-coated erythromycin (PCE). Each patient was randomized to receive either IM betamethasone or IM placebo. All patients were contacted by telephone at 24 and 48 hours 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 between the third and seventh days after the initial visit to determine the time of pain resolution. Results: A total of 92 patients were enrolled in the study, with 46 randomized to receive placebo and 46 to receive betamethasone. Eight patients were excluded from the statistical analysis because of inability to obtain follow-up. Demographic comparison showed that gender distributions, ages, mean initial pain scores, mean times to the first and second follow-up calls, and treatment regimens were similar in the 2 groups. There were significantly better pain scores for the betamethasone group a t first follow-up ( p = 0.0005), at second followup ( p = 0.004), and in number of hours until relief of pain ( p = 0.004). When only those patients with a positive culture for a streptococcus species were analyzed, there also were significant reductions in pain score a t the first ( p = 0.006) and second ( p = 0.02) follow-up visits. Conclusion: Pain relief was greater and more rapid in patients treated with betamethasone as a n adjuvant therapy in acute exudative pharyngitis.

Corticosteroids for treatment of sore throat: systematic review and meta-analysis of randomised trials

“…Eight studies recruited patients from hospital emergency departments23 24 25 26 27 28 29 30 and two from primary care 1631 Three studies enrolled children,27 28 29 six studies enrolled adults,16 24 25 26 30 31 and one study included both children and adults 23. Oral dexamethasone (single dose of 10 mg for adults and 0.6 mg/kg, maximum 10 mg for children) was the most common intervention (five studies) followed by single dose intramuscular injection of dexamethasone (three studies).…”

“…24 26 28 One study had issues in more than one category of risk 26. The three remaining studies had issues in concealment of the treatment allocation, incomplete outcome reporting, and blinding of outcome assessors.…”

“…In the eight studies that reported mean time to onset of pain relief,16 23 24 25 26 27 28 30 patients who received corticosteroids experienced onset of pain relief on average 4.8 hours earlier than those who received placebo (95% confidence interval −1.9 to −7.8; I 2 =78%; moderate quality; fig 4, table 2). We found no evidence of subgroup effect for this outcome (table A in appendix 3).…”

“…23 24 27 28 30 On average, patients receiving a single dose corticosteroid experienced complete resolution 11.1 hours earlier (95% confidence interval −0.4 to −21.8; I 2 =85%; low quality; fig 5, table 2). In our subgroup analysis, we found a significantly larger effect among those treated with intramuscular corticosteroids (mean difference −22.4 (95% confidence interval −27.3 to −17.5) and −1.5 (−12.6 to 9.5), for intramuscular and oral corticosteroids, respectively; P=0.001 for interaction); however, the effect modification is suggested by comparison between rather than within studies.…”

“…Meta-analysis from eight studies that assessed pain with a visual analogue scale (0=no pain, 10=maximum pain) at baseline and after 24 hours16 23 24 25 26 27 28 31 showed a 1.3 points lower pain score among patients treated with corticosteroids compared with those treated with placebo at 24 hours (95% confidence interval 0.7 to 1.9; I 2 =65%; moderate quality; fig 6, table 2). We found no evidence of subgroup effect for this outcome (table B in appendix 3).…”