A randomized clinical trial of oral versus intramuscular delivery of steroids in acute exudative pharyngitis.
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.
Marvez-Valls
Eduardo G
EG
Department of Medicine, Division of Emergency Medicine, Louisiana State University, New Orleans, LA, USA.
Stuckey
Ashley
A
Ernst
Amy A
AA
D000208:Acute Disease; D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D003907:Dexamethasone / Q000008:administration & dosage*; D004311:Double-Blind Method; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D010612:Pharyngitis / Q000188:drug therapy* / Q000382:microbiology; D011241:Prednisone / Q000008:administration & dosage*; D011336:Probability; D012494:Sampling Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013290:Streptococcal Infections / Q000175:diagnosis / Q000188:drug therapy*; D013297:Streptococcus pyogenes / Q000302:isolation & purification*; D016896:Treatment Outcome
D003907:Dexamethasone; D011241:Prednisone