Dr Gail Hayward’s research published by JAMA
Research by Exeter College’s Staines Medical Research Fellow Dr Gail Hayward has been published by the Journal of the American Medical Association (JAMA). Dr Hayward ran a clinical trial to investigate the effect of steroids on severe sore throats.
The question Dr Hayward raised was: does a single dose of dexamethasone provide symptom relief for acute sore throat in adults presenting to primary care who are not also taking antibiotics? She conducted a randomised clinical trial including 565 adults. Half received an oral dose of dexamethasone, half received a placebo.
The trial found that after 24 hours there was not a significant difference between the proportion of patients from the dexamethasone group achieving complete symptom resolution and those taking placebo. However after 48 hours there was a significant difference between the two groups: 35% of patients who had taken steroids felt better, compared to 27% of those who hadn’t. There was no evidence that taking steroids affected the amount of time patients took off work, the duration of moderately bad symptoms, or the use of antibiotics.
Dr Hayward points out that there are some significant downsides to prescribing steroids for sore throats. For example in the short-term they can cause increased appetite, difficulty sleeping and acid reflux, and recent evidence from a US population study has suggested an association between taking even short courses of steroids and an increased risk of clots, fractures and sepsis.
After the study Dr Hayward said: ‘The take-away message to clinicians and patients is that our study findings do not support the routine use of steroids for sore throats in primary care. Steroids did not affect the overall burden of symptoms in patients, did not reduce time off work, and did not reduce the amount of antibiotics used. We did find that they improved the chances of complete resolution of symptoms at 48 hours, but this needs to be taken in the context of the short- and long-term side effects of steroids, and we don’t think in this context it’s a clinically significant difference.’