A pilot study of 1 versus 3 days of dexamethasone as add-on therapy in children with streptococcal pharyngitis.
BACKGROUND
Studies in adults, but not in children, have shown a beneficial effect of one dose of steroid on the severity and duration of throat pain in acute pharyngitis. The effectiveness of longer steroid treatment has not been evaluated in children.


METHODS
We performed a randomized, double-blind, 3-arm, placebo-controlled trial to estimate the effectiveness of one dose versus 3 daily doses of oral dexamethasone in the treatment of 4- to 21-year-old patients with group A beta-hemolytic streptococcal (GABHS) pharyngitis. Participants used the Wong-Baker FACES scale to rate their symptoms at enrollment and twice daily for 5 days. Patient-completed diaries and telephone interviews provided follow-up data. Primary end points-severity of throat pain, improvement in general condition and improvement in activity level-were evaluated by survival analysis.


RESULTS
Ninety patients were enrolled. For each end point, we rejected the null hypothesis of a common survival experience for the 3 study arms. With the exception of 2 days for throat pain in participants receiving one dose of dexamethasone, the median time to improvement for all end points was 1 day for both arms of dexamethasone and 2 days for placebo. There was no difference between study arms in return to a clinical setting for symptoms related to GABHS pharyngitis or absenteeism from work/school. No patient experienced complications related to GABHS pharyngitis in the 30 days after enrollment.


CONCLUSIONS
In this pilot study, children with GABHS pharyngitis who receive dexamethasone as add-on therapy have a more rapid improvement in general condition and level of activity and, for those receiving 3 daily doses of dexamethasone, in resolution of throat pain.
Niland
Mary-Lynn
ML
Department of Pediatrics, Section of Emergency Medicine, Children's Hospital, The Ohio State University, Columbus, OH 43205, USA. nilandm@pediatrics.ohio-state.edu
Bonsu
Bema K
BK
Nuss
Kathryn E
KE
Goodman
Deborah G
DG
D000208:Acute Disease; D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D003907:Dexamethasone / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D010612:Pharyngitis / Q000188:drug therapy* / Q000382:microbiology*; D010865:Pilot Projects; D011336:Probability; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012016:Reference Values; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013290:Streptococcal Infections / Q000175:diagnosis / Q000188:drug therapy*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D003907:Dexamethasone