Prednisone treatment for severe pharyngitis in the community: A randomised controlled doubleblind tr

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Prednisone treatment for severe pharyngitis in
the communityA randomised controlled
double-blind trial

• Alexander Kiderman, John Yaphe, Yosef Bregman,
  Tamar Peyser-Zemel, Arthur Furst
• Departments of Family Medicine, Hadassah Medical
  Organization, Jerusalem and Rabin Medical Centre,
  Petach Tikvah, Israel
• and Clalit Health Services

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Background

• Pharyngitis is a common reason for encounter in
  general practice and results in suffering and
  time off work and school.
• Evidence from emergency department studies in the
  US suggests that parenteral steroids may shorten
  the course of pharyngitis and decrease the
  severity of the illness.

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Study question

• Does short term treatment with prednisone in
  addition to standard antibiotic therapy decrease
  the severity of pharyngitis and speed the return
  to normal function in adults treated in the
  community?

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Method

• Study population All adults presenting with
  tonsillitis in five general practices.
• Inclusion criteria throat pain,and at least two
  of the following fever, exudate, dysphagia,
  lymphadenopathy
• Exclusion minors, pregnancy, steroid use,
  malignancy, diabetes, immunodefficiency

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Method (2)

• Informed consent (Helsinki approval)
• Randomization (random number table)
• Prednisone or placebo tablets given along with
  routine antibiotic therapy.
• 60 mg dose on day 1, 60 mg on day 2
• Follow-up at 8-12, 24, 48, 72 hours
• Use of visual analogue scale

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Visual analogue scale
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Analysis

• t-test to compare pain scores
• Chi-squared test to compare proportions of
  patients with symptoms
• Significance set at 0.05 level

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Results

• 51 patients enrolled in trial (1 refused after
  entry).
• The prednisone group had more females and
  patients with more severe symptoms but was
  otherwise similar to the placebo group.

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Characteristics at entry
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Results (2)

• Significantly lower pain score at 8-12, 24 and 48
  hours in prednisone group.
• Greater percent fall in pain score in prednisone
  group at 8-12, 24 and 48 hours.
• Fewer patients with any pain or dysphagia in
  prednisone group.
• No difference in fever or off work
• No significant adverse effects or recurrence

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Conclusions

• Addition of prednisone to standard antibiotic
  therapy in pharyngitis in adults can decrease the
  severity and duration of pain.
• There is no significant effect of prednisone on
  fever or time off work or school.