General

Prednisolone for sore throat?

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1 Jul 2016 - General
 

Anyone has any views on General practitioners prescribing prednisolone for straight forward viral upper respiratory tract infections?

True enough, we all know that prednisolone is a wonder drug when it comes to anti-inflammatory function and when patients come to see a doctor for sore throat, it relieves the sore throat quite effectively. Some may argue that they give it to reduce the hypersensitive airway in asthmatic patients - which is the correct way of management, but what if it is for sore throat just to relieve the pain? That will be unethical as prednisolone can have multiple side effects - even though it is just a short course, immune system can be impaired and further worsen the viral infection.

I seldom prescribe steroids for URTI, because of the possibility of side effects, which can be mild like acne or water retention to moderate like gastritis or more severe like worsening DM or HTN control. BUT, for the purpose of discussion, I did find a review of some RCTs (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2807390/) that suggests that steroids can help with the pain associated with acute pharyngitis. Most of the patients in the RCTs had antibiotics from the start *and* also had analge...
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Yeah Centor scoring is usually used for likelihood of strep A vs infectious mononucleosis when there is a case of tonsilitis. score of 4 and above is likely predictive of Group A strep. 2 and below are unlikely. The importance of this is to start penicillin early to avoid complications of rheumatic fever and glomerulonephritis. And of course if a patient has a low centor score but tonsilitis, amoxicillin and ampillin have to be avoided to prevent maculopapular eruption in infectious mononucleo...
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I feel using prednisolone for sorethroat is not evidence based and sorethorat is self limiting. Are we exposing the patient to risk of developing a secondary bacterial infection, bacterial sinutiis or pneumonia? Sorethroat is simple and straightforward. If we try prednisolone on a case of severe strep A tonsilitis ( centor 4 and above ) and the patient is having very severe symptoms, we can try prednisolone with penicillin. Giving just any other infective sorethroat prednisolone is not evidence ...
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