Clinical Efficacy of Dexamethasone for Acute Exudative Pharyngitis
The objective of this study was to investigate whether treatment with single-dose dexamethasone can provide relief of symptoms in acute exudative pharyngitis. A prospective, randomized, double-blinded, placebo-controlled clinical trial was undertaken over a 3-month period in a university-based Emergency Department. The study included all consecutive patients between 18 and 65 years of age presenting with acute exudative pharyngitis, sore throat, odynophagia, or a combination, and with more than two Centor criteria. Each patient was empirically treated with azithromycin and paracetamol for 3 days. The effects of placebo and a fixed single dose (8 mg) of intramuscular injection of dexamethasone were compared. The patients were asked to report the exact time to onset of pain relief and time to complete relief of pain. After completion of the treatment, telephone follow-up regarding the relief of pain was conducted. A total of 103 patients were enrolled. Thirty patients with a history of recent antibiotic use, pregnancy, those who were elderly (> 65 years of age) and patients who failed to give informed consent were excluded. Forty-two patients were assigned to the placebo group and 31 were assigned to the intramuscular dexamethasone group (8-mg single dose). Time to perceived onset of pain relief was 8.06 ± 4.86 h in steroid-treated patients, as opposed to 19.90 ± 9.39 h in the control group (p = 0.000). The interval required to become pain-free was 28.97 ± 12.00 h in the dexamethasone group, vs. 53.74 ± 16.23 h in the placebo group (p = 0.000). No significant difference was observed in vital signs between the regimens. No side effects and no new complaints attributable to the dexamethasone and azithromycin were observed. Sore throat and odynophagia in patients with acute exudative pharyngitis may respond better to treatment with an 8-mg single dose of intramuscular dexamethasone accompanied by an antibiotic regimen than to antibiotics alone.

Acute pharyngitis is described as an inflammation of the pharynx and surrounding lymphoid tissue. Viruses are the most common cause of acute pharyngitis. The most common bacteria causing pharyngitis is the group of A ß-hemolytic streptococcus (streptococcus pyogenes) (GABHS). The etiologic pathogen is not observed in 50% of all cases of pharyngitis, even though full bacteriological and virologic investigations are performed.

Centor criteria, including history of fever, absence of cough, tender anterior cervical lymph nodes, and exudate, are the most reliable clinical parameters for GABHS pharyngitis. The presence of three or four of these criteria has a positive predictive value of 40-60%. The absence of three or four of the criteria has a negative predictive value of 80%. Both the sensitivity and specificity of this prediction rule are 75%, compared with throat cultures.

Most adult cases of pharyngitis are limited to the infection itself and merely require supportive treatment. The standard approach to therapy includes antipyretics, analgesics, and antibiotics if necessary. Symptomatic treatments, including gargling with warm saltwater, drinking warm liquids, and bed rest should be suggested to all patients with pharyngitis. The acute pharyngitis that is caused by GABHS is the only type that requires antibiotic treatment. Antibiotic treatment affects the recovery and will help protect from acute rheumatic fever.

Convenient antibiotics fail to relieve the inflammatory symptoms in patients with GABHS pharyngitis. The patients who have inflammatory complaints benefit from anti-inflammatory drugs given within 24 h. Administration of steroids was based on throat cultures in most previous studies. However, steroids are probably not universally used by emergency physicians. The present study sought to identify clinical criteria that would help to select patients for steroid use. We aimed to select patients using three or four clinical criteria and then determine whether a single dose of steroid would relieve symptoms in exudative pharyngitis.