Does Dexamethasone Aid the Treatment of Strep Pharyngitis in Children?

When added to antibiotics, steroids have been shown to reduce the severity and duration of acute exudative pharyngitis in adults. Studies involving children have been less conclusive and have tested only single-dose treatment regimens.

Researchers conducted a randomized, double-blind, placebo-controlled trial with three arms: three once-daily doses of oral dexamethasone (0.6 mg/kg; maximum, 10 mg); a single dose of oral dexamethasone; and placebo. Enrollment in the convenience sample was limited to children aged 4–21 years who presented to a single emergency department and had a positive direct streptococcal antigen assay. While in the ED, patients received antibiotics and analgesia at the discretion of the clinician, rated their pain using a validated 6-point FACES scale, and were randomized to one of the study arms. Follow-up consisted of twice-daily recording of symptoms in diaries, as well as telephone interviews on days 1, 2, and 5 post-enrollment. The primary outcomes were improvement or resolution of throat pain and return to general health and normal activity level.

Eighty-four patients were included in the analysis. The relative benefits of the 3-dose steroid regimen over placebo were 2.1 for relieving sore throat, 1.7 for improving general health, and 2.3 for promoting return to general activity (all statistically significant). For the single-dose regimen, the relative benefit for improvement in general condition was 1.9 and for return to normal activity was 2.3, both significant. There was no relative benefit in relieving throat pain with the single-dose regimen. Overall, there was no significant difference among the three groups in the complete resolution of sore throat or in a number of secondary outcomes like missed days of school or work. No complications were noted within 30 days of enrollment.