Study Question: Does dexamethasone decrease pain in children with acute pharyngitis?

Setting: Emergency department

Study Design: Randomized controlled trial (double-blinded)

Synopsis: Researchers enrolled 184 children presenting to an emergency department with sore throat; 99 tested positive for group A beta-hemolytic streptococcus (GABHS). The children were five to 16 years of age and had symptoms for less than 48 hours. Allocation to treatment group was concealed from the investigators.

Children were given placebo or dexamethasone in a dosage of 10 mg per day, along with nonprescription analgesics and penicillin in children who were GABHS-positive. The study was large enough to find a clinically significant 2-cm change on a 10-cm visual analog pain scale. In children with GABHS infection, dexamethasone decreased the time to clinically significant pain relief (six versus 11.5 hours with placebo;P =.02), but not the time to complete pain relief. However, no difference was noted in pain scores in the children without GABHS infection.

Bottom Line: Using corticosteroid therapy in children with acute pharyngitis does not have a clinically important effect on pain. (Level of Evidence: 1c)