Table 1.
Characteristics of trials included in meta-analysis (see web appendix for references)
| Study | Age range (mean)* | No of patients analysed | Severity of sore throat | Intervention | Control | Antibiotics used | Analgesia | Outcomes | |
|---|---|---|---|---|---|---|---|---|---|
| Intervention | Control | ||||||||
| O’Brien et al 1993 (US)w8 | 12–65 (26.4) | 26† | 25† | Severe (GABHS not tested, 100% exudative) | Dexamethasone 10 mg (IM) | Saline 1 ml (IM) | Penicillin G or erythromycin | Unregulated, no differences recorded, type not reported | Reduction in pain VAS, time to onset of pain relief, time to complete pain resolution |
| Marvez-Valls et al 1998 (US)w4 | 14-65 (29.1) | 46 | 46 | Severity not stated (53% GABHS‡, 100% exudative) | Betamethasone 8 mg/2 ml§ (IM) | Saline, 2 ml (IM) | Penicillin G or erythromycin (similar proportion in each group) | Unregulated, unrecorded, paracetamol or ibuprofen recommended | Reduction in pain VAS, time to onset of pain relief, time to complete pain resolution, days missed from school or work, percentage of recurrence |
| Wei et al 2002 (US)w6 | ≥15 (28) | 42¶ | 37 | Severity not stated (27% GABHS, 43% exudative) | Dexamethasone 10 mg (PO) + placebo (IM)¶ | Placebo (PO, IM) | Penicillin V or erythromycin | Paracetamol for first 24 hours as required, no differences recorded | Reduction in VAS, complete pain resolution at 24 hours, return to normal activity, ability to take liquids and solids, percentage of recurrence |
| Bulloch et al 2003 (Canada)w3 | 5-16 (9.74) | 92 | 92 | Severity not stated (46% GABHS, 37% exudative) | Dexamethasone, 0.6 mg/kg (PO, maximum 10 mg) | Placebo (PO) | Penicillin V if DAT positive | Unregulated, unrecorded | Reduction in pain VAS, time to onset of pain relief, time to complete pain resolution, percentage of recurrence |
| Olympia et al 2005 (US)w5 | 5–18 (11.9) | 57 | 68 | Severe (56% GABHS, exudative not stated) | Dexamethasone, 0.6 mg/kg (PO, maximum 10 mg) | Placebo (PO) | Penicillin G, erythromycin or azithromycin if DAT positive or culture positive | Unregulated, no differences recorded, paracetamol or NSAIDs recommended | Reduction in pain, McGrath score, time to onset of pain relief, time to complete pain resolution, fever, associated symptoms, need for further medical care |
| Kiderman et al 2005 (Israel)w1 | 18-65 (33.9) | 40 | 39 | Severe (57% GABHS, 87% exudative) | Prednisone, 60 mg for 1 or 2 days (PO)** | Placebo (PO) | Penicillin V, amoxicillin, erythromycin, none at GP’s discretion, or stopped if culture negative | Unregulated, unrecorded | Reduction in VAS score, proportion of individuals being pain-free at various time points, percentage of recurrence, complete pain resolution at 24 and 48 hours, days missed from school or work |
| Niland et al 2006 (US)w2 | 4-21 (median 7.7) | 30†† | 30 | Severity not stated (100% GABHS, 57% exudative) | Dexamethasone, 0.6 mg/kg for 1 day (PO, maximum 10 mg) + 2 days placebo | Placebo (PO) | 50% received IM and 50% received PO antibiotic, type not stated | Unregulated, no differences recorded | Return of general health, return of normal activity level, days missed from school or work, time to complete pain resolution, complete pain resolution at 24 and 48 hours, percentage of recurrence |
| Tasar et al 2008 (Turkey)w7 | 18-65 (31.3) | 31 | 42 | Severity not stated (GABHS not stated, exudative not stated) | Dexamethasone, 8 mg (IM) | Saline (IM) | Azithromycin, 500 mg daily for 3 days | Paracetamol for 3 days as required, unrecorded | Time to onset of pain relief, time to complete pain resolution, complete pain resolution at 24 and 48 hours |
GABHS=group A β-haemolytic streptococcus. IM=intramuscular delivery. PO=oral delivery. DAT=direct antigen test. VAS=visual analogue scale.
*Age in years. Value in parentheses is the mean unless stated otherwise.
†13 participants in each arm available for follow-up at 7 days to determine complete resolution.
‡84% of participants had throat cultures taken, percentage is reported as if all participants had cultures.
§Dose is a best guess from US formularies.
¶Third arm of trial examining IM dexamethasone not included in general analysis.
**Data from two doses of corticosteroid versus one dose not presented separately.
††Third arm of trial evaluating three daily doses of dexamethasone not included in meta-analysis.