Wednesday, May 3, 2017

Wisdom Wednesday: Is it Wise to Take a Steroid for a Sore Throat?

Researchers seeking new sore throat treatments reportedly modest success with a single dose of a steroid medication.

Concerns about growing bacterial resistance to antibiotics have lead scientists to look for alternative therapies for sore throat, a common reason for doctor visits.

In this new British study, a steroid medication led to improvement in about one-third of patients with sore throat. But two U.S. physicians said they aren’t rushing to prescribe the drugs on the basis of these results.

The new study looks at a steroid – a drug designed to dampen immune system responses. Researchers led by Gail Nicola Hayward, of the University of Oxford, analyzed the effects of a single dose of dexamethasone. Similar steroids include prednisone and methylprednisolone.

The researchers randomly assigned 565 adults in England with a sore throat that didn’t require an antibiotic to take a large dose of dexamethasone (10 mg) or a placebo. Half the patients were younger than 34.

At 24 hours, the 288 patients who took the medication fared about the same as the 277 who didn’t. But at 48 hours, more than one-third of those who took the drug – 102 – had recovered.

According to Dr. Robert Centor, a professor of internal medicine at the University of Alabama at Birmingham, U.S. physicians don’t often prescribe steroids for sore throats. However, some emergency rooms and urgent care centers appear to do so. “It’s not standard treatment or in any guideline, but these people [physicians] say, ‘Well we can make them feel better. How could a couple days of steroids even hurt?’”

But there’s a risk that the drugs could hide symptoms that something serious is going on, Centor said.

Side effects from steroids are also possible but rare, according to Dr. Jeffrey Linder of Northwestern University School of Medicine in Chicago. “They include increased blood pressure, increased blood sugar, fluid retention,” he said. “They could be significant for people at risk for diabetes complications and at risk for cardiovascular disease,” said Linder.

The study results were published April 18 in the Journal of the American Medical Association.

My Take:
The use of steroids for a sore throat or a chronic cough is a growing trend in medical practice. I see the side effects quite often now in the clinical setting.

Certainly, some of popularity comes from concerns about overusing antibiotics, especially when 90% of upper respiratory infections are viral and do not respond to antibiotic therapy.

However, they are just trading one inappropriate therapy for an equally dangerous, inappropriate therapy. Steroids are adrenal hormone analogs – they look and act much like the hormones produced from our adrenal glands. The use of synthetic hormones, even short term, for conditions that resolve without treatment is ill advised.

I have had two of my patients die from cortisone therapy. In both cases, the patients were treated for a cough of unknown cause. No disease, other than the induced cortisone disease, was identified prior to their death. Many others have suffered serious damage to their endocrine and cardiovascular systems from prolonged steroid treatment. Steroids suppress adrenal and thyroid function in addition to suppressing the immune system as noted above.

The Bottom Line:
Do not take steroids or antibiotics for a sore throat. Gargle with colloidal silver every couple of waking hours. Typically, the condition will resolve in 1-2 days. If you have not improved in 3 days, consult with your physician.

Source: April 18, 2017 National Institutes of Health

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