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QUESTION: In patients with acute sore throat, are non-antibiotic treatments effective?
Studies were identified by searching Medline (from 1966) and the Cochrane Controlled Trials Registry.
Studies in any language were selected if they were controlled trials of any non-antibiotic intervention in a clinical setting. Exclusion criteria were excessive dropouts, no treatment, and unclear randomisation and blinding.
Data were extracted on type of treatment, definition of illness, patient characteristics, setting, blinding, and estimate of treatment effect. Outcome measures were patient centred sore throat symptoms.
22 randomised, blinded, controlled trials met the selection criteria. 7 studies involved children only, and 10 involved adults only. 10 studies measured short term outcomes (<24 h). The table shows the results.
In patients with acute sore throat, ibuprofen, steroids, non-steroidal anti-inflammatory drugs (NSAIDs), and paracetamol (acetaminophen) reduce sore throat in the short term (<24 h). Longer term effective treatments include paracetamol, NSAIDs, supercolonisation with benign bacteria, better doctor-patient communication, and vaccination against influenza and pneumococcus.
Sore throat is one of the most common conditions managed in primary care. Irrespective of the cause and whether antibiotics can be targeted to prevent complications,1, 2 patients require help with symptoms. The review by Thomas et al is important in bringing together a diverse range of evidence for non-antibiotic management, particularly given current concerns about resistance and the marginal effectiveness of antibiotics for the symptoms of sore throat in most patients.2
These data suggest that paracetamol, aspirin, and other NSAIDs are effective, although there is no evidence that NSAIDs—with their greater side effects—are more effective than paracetamol alone.3 Vaccination and α streptococcal spray may also help, although the practicalities and cost effectiveness of such interventions are unclear. Some care is also required in interpreting the data: the estimates of treatment effect are relative and refer to diverse outcomes (pain severity, symptom resolution, and recurrence), and most studies were not done in typical primary care settings.
Clearly, more evidence is needed in primary care settings about the safety and effectiveness of non-antibiotic treatments. Nevertheless, these data should give doctors confidence that, on the basis of current evidence, non-antibiotic treatments are probably at least as effective as if not more effective than antibiotic treatment for the symptoms of sore throat.
Source of funding: no external funding.
For correspondence: Professor C Del Mar, Centre for General Practice, Graduate School of Medicine, University of Queensland, Herston, Queensland 4006, Australia. Fax +61 7 3365-5442.
A modified version of this abstract appears in Evidence-Based Nursing.