Prednisone treatment for severe pharyngitis in the community A by stephan2

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									Prednisone treatment for severe
pharyngitis in the community:
A randomised controlled double-blind trial



       Alexander Kiderman, John
       Yaphe, Yosef Bregman, Tamar
       Peyser-Zemel, Arthur Furst

       Departments of Family Medicine,
       Hadassah Medical Organization,
       Jerusalem and Rabin Medical
       Centre, Petach Tikvah, Israel
       and Clalit Health Services
Background

• Pharyngitis is a common reason for
  encounter in general practice and results
  in suffering and time off work and school.
• Evidence from emergency department
  studies in the US suggests that parenteral
  steroids may shorten the course of
  pharyngitis and decrease the severity of
  the illness.
Study question

• Does short term treatment with
  prednisone in addition to standard
  antibiotic therapy decrease the severity of
  pharyngitis and speed the return to
  normal function in adults treated in the
  community?
Method

• Study population: All adults presenting
  with tonsillitis in five general practices.
• Inclusion criteria: throat pain,and at least
  two of the following: fever, exudate,
  dysphagia, lymphadenopathy
• Exclusion: minors, pregnancy, steroid use,
  malignancy, diabetes, immunodefficiency
Method (2)

• Informed consent (Helsinki approval)
• Randomization (random number table)
• Prednisone or placebo tablets given along
  with routine antibiotic therapy.
• 60 mg dose on day 1, 60 mg on day 2
• Follow-up at 8-12, 24, 48, 72 hours
• Use of visual analogue scale
Visual analogue scale
Analysis

• t-test to compare pain scores
• Chi-squared test to compare proportions
  of patients with symptoms
• Significance set at 0.05 level
Results

• 51 patients enrolled in trial (1 refused
  after entry).
• The prednisone group had more females
  and patients with more severe symptoms
  but was otherwise similar to the placebo
  group.
  Characteristics at entry
                 Prednisone   Placebo
Mean age             34          35       ns
Sex (%female)        80          48     p<0.05
pain %              100         100       ns
fever %              72          68       ns
exudate %            92          84       ns
nodes %              96          88       ns
dyspahgia %         100         100       ns
Mean VAS             8           7      p<0.05
off work given %     60          56       ns
Strep swab + %       52          64       ns
Results (2)

• Significantly lower pain score at 8-12, 24 and 48
  hours in prednisone group.
• Greater percent fall in pain score in prednisone
  group at 8-12, 24 and 48 hours.
• Fewer patients with any pain or dysphagia in
  prednisone group.
• No difference in fever or off work
• No significant adverse effects or recurrence
                     VAS pain score for prednisone vs. placebo in pharyngitis

             9

             8

             7
pain score




             6

             5

             4

             3
                       p<0.00005
             2
                                     p<0.02
             1                                                p<0.05
             0

                 0          12        24           36          48       60      72
                                              time in hours

                                    prednisone n=25      placebo n=25
                             Percent fall in pain score

    90
                                                                            85
    80                                                       82
                                                                            78
    70                  71

    60        59                                             59

    50
%




    40
                        34
    30

    20
              13
    10

    0
         12        24              36                   48        60   72
                                        Time in hours

                                 prednisone n=25   placebo n=25
            % of pain-free patients with pharyngitis

100

80
                    p<0.01
60
          p<0.01
40

20

 0
      0      12       24           36        48        60   72
                             Time in hours

                           prednisone    placebo
             % of pharyngitis patients with dysphagia

100
80
60
          p<0.01
40
                    p<0.05
20
 0
      0       12        24           36        48       60   72
                               Time in hours

                             prednisone    placebo
          % of pharyngitis patients with fever

100
80
60
40
20
 0
      0   12       24           36        48     60   72
                          Time in hours

                        prednisone    placebo
              % of pharyngitis patients off work

80
60
40
20
0
     0   12          24          36         48     60   72
                            Time in hours

                          prednisone    placebo
Conclusions

• Addition of prednisone to standard
  antibiotic therapy in pharyngitis in adults
  can decrease the severity and duration of
  pain.
• There is no significant effect of
  prednisone on fever or time off work or
  school.

								
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