Clinical Question: Does treatment with dexamethasone reduce throat pain in patients with acute mononucleosis?

Setting: Emergency department

Study Design: Randomized controlled trial (double-blinded)

Synopsis: In this small study, the investigators enrolled children between eight and 18 years of age with suspected mononucleosis. The 40 children were assigned randomly (masked allocation) to receive a single oral dose of dexamethasone (0.3 mg per kg, maximum dose: 15 mg) or a matched placebo. Pain was measured using a 100-mm visual analog scale, with a 20-mm or greater difference chosen as the primary outcome. Pain was assessed 12, 24, 48, and 72 hours after treatment, and then one final time on day 7. Analysis was by intention to treat.

To assess the quality of blinding, the investigators tried to guess whether participants received dexamethasone or placebo after patients completed the pain scale, but were unable to do so. At the 12-hour assessment, 12 of the 20 patients in the dexamethasone group improved (at least 20 mm on the scale) compared with five of the 19 patients taking placebo (number needed to treat = four; P = .03). At 24 hours, approximately one half of the patients treated with dexamethasone (11 out of 20) had pain relief compared with one third (six out of 20) taking placebo. The study did not have sufficient power to detect whether this difference was real or not. Assessments after the first 24 hours were virtually identical.

Bottom Line: Dexamethasone provides improvement in throat pain in children with acute mononucleosis, but the effect lasts less than 24 hours. (Level of Evidence: 1b–)