Corticosteroid có thể giúp giảm đau trong viêm họng

Corticosteroids May Help Relieve Pain of Sore Throat

Laurie Barclay, MD


17/8/2009- Corticosteroids có thể giúp giảm đau trong viêm họng khi kết hợp cùng với kháng  sinh ở những bệnh nhân biểu hiện đau họng nhiều, theo kết quả của một nghiên cứu hệ thống vào 7 tháng 8 của Online First issue  thời báo BMJ.

Come on… Dịch tiếp đi bà con. hehehe. Update đó…

August 17, 2009 — Corticosteroids may help relieve sore throat pain when added to antibiotics in patients with severe or exudative sore throat, according to the results of a systematic review and meta-analysis reported in the August 7 Online First issue of the BMJ.

“The pressure for clinicians to reduce antibiotic prescriptions for sore throat leaves a therapeutic vacuum,” write Gail Hayward, University of Oxford, Oxford, United Kingdom, and colleagues. “Corticosteroids inhibit transcription of proinflammatory mediators in human airway endothelial cells which cause pharyngeal inflammation and ultimately symptoms of pain. Corticosteroids are beneficial in other upper respiratory tract infections such as acute sinusitis, croup, and infectious mononucleosis.”

To determine whether systemic corticosteroids appear to relieve symptoms of sore throat in adults and children, the reviewers searched Cochrane Central, Medline, Embase, Database of Reviews of Effectiveness, NHS Health Economics Database, and reference lists of retrieved articles. Pertinent endpoints included percentage of patients with complete resolution of sore throat at 24 and 48 hours, mean time to onset of pain relief, mean time to complete resolution of symptoms, days absent from work or school, recurrence of sore throat, and adverse events.

The reviewers identified 8 relevant trials enrolling a total of 743 patients, including 369 children and 374 adults. Exudative sore throat was present in 348 (47%) of these patients, and 330 (44%) tested positive for group A β-hemolytic streptococcus.

Four trials showed that when added to antibiotics and analgesia, corticosteroids were associated with significant, marked improvement in the likelihood of complete pain resolution at 24 hours (relative risk [RR], 3.2; 95% confidence interval [CI], 2.0 – 5.1). Three trials showed similar but less dramatic results at 48 hours (RR, 1.7; 95% CI 1.3 – 2.1).

In 6 trials, corticosteroids were associated with decrease by more than 6 hours in mean time to onset of pain relief (95% CI, 3.4 – 9.3; P < .001). However, there was significant heterogeneity in these trials, and the mean time to complete resolution was inconsistent across trials, precluding pooled analysis. For other outcomes, reporting was limited.

“Corticosteroids provide symptomatic relief of pain in sore throat, in addition to antibiotic therapy, mainly in participants with severe or exudative sore throat,” the study authors write.

Limitations of this study include inadequate reporting for some outcomes, recall bias, inability to assess publication bias, and significant heterogeneity in some analyses. An important limitation was use of antibiotics in both corticosteroid and placebo groups, either to all participants, or to all participants with group A β-hemolytic streptococcus culture result or a positive result on rapid antigen test.

“Our findings suggest that in patients with severe or exudative sore throat, pain can be reduced and resolution hastened by use of corticosteroids in conjunction with antibiotic therapy,” the study authors conclude. “Our research suggests that patients with severe or high Centor scoring sore throat would benefit from a single dose of corticosteroids. The use of corticosteroids will triple the likelihood of resolution at 24 hours and hasten this resolution by more than 6 hours, even in patients who have also been given antibiotics and analgesics.”

In an accompanying editorial, Paul Little, from the University of Southampton in Southampton, United Kingdom, notes that the complications of steroids cannot be investigated in a meta-analysis of this size.

“Clearly more research is needed, particularly more robust evidence for the use of oral steroids in more typical populations and in patients not receiving antibiotics; better data are also needed about the likely incidence of rare complications in primary care,” Dr. Little writes. “In the meantime, what should clinicians advise their patients given these uncertainties? Clinicians should outline the evidence for the efficacy of steroids in terms of pain control during the first 24 hours (in terms of how rapidly the placebo groups settle and the additional benefit from steroids), convey the slight uncertainty about rare side effects, and then let the patient decide.”

The British Society for Antimicrobial Chemotherapy Systematic Review funded this work in part. The review authors and Dr. Little have disclosed no relevant financial relationships.

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