| Study characteristics |
| Methods |
Prospective, randomised, double‐blind, placebo‐controlled trial in an emergency department setting in the USA. 7‐day follow‐up |
| Participants |
58 participants aged 12 to 65 years (mean 26.3) with visible tonsillar exudate, severe odynophagia or dysphagia, and either fever or cervical adenopathy |
| Interventions |
Dexamethasone 10 mg IM (10 mg/mL) (31 participants) or 1 mL saline IM (27 participants). 10‐day course of either penicillin V or erythromycin supplied to all participants. |
| Outcomes |
Reduction in pain VAS. Time to onset of pain relief. Time to complete pain resolution |
| Notes |
Analgesia recorded but not regulated. Funding source/declaration of interest: not declared. No contact with study authors. |
| Risk of bias |
| Bias |
Authors' judgement |
Support for judgement |
| Random sequence generation (selection bias) |
Low risk |
Random numbers table |
| Allocation concealment (selection bias) |
Low risk |
Syringes containing the 2 preparations were indistinguishable. |
| Blinding (performance bias and detection bias)
All outcomes |
Low risk |
Physicians, nurses, and participants blinded to the study drug. |
| Incomplete outcome data (attrition bias)
All outcomes |
Unclear risk |
Primary outcome at 24 hours: 7/58 lost to follow‐up. Secondary outcome of time to complete pain resolution: 32/58 participants lost to follow‐up |
| Selective reporting (reporting bias) |
Low risk |
All outcomes reported. |
| Comparability of groups at baseline |
Low risk |
Comparable |
