Corticosteroids added to antibiotic for sore throats

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Original sender's name: Sheri Nakken Original sender's address: vaccinedangers > Antibiotics are enough of a problem but to add > steroids................good grief> Sheri> > > From < http://www.medscape.com/news> Medscape Medical News> Corticosteroids May Help Relieve Pain of Sore Throat> Laurie Barclay, MD> > > 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./> > /BMJ/. Published online August 7, 2009. Abstract> < http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=19661138 & dopt=Abstract> > > Sheri Nakken, R.N., MA, Hahnemannian Homeopath> http://www.wellwithin1.com/vaccine.htm & http://www.wellwithin1.com/homeo.htm> ONLINE/Email classes in Homeopathy; Vaccine Dangers; Childhood Diseases Reality> Next classes start September 9 & 10