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QUESTION: Are non-antibiotic treatments effective for acute sore throat?
Randomised controlled trials from 1966 onwards were identified by searching the Cochrane Controlled Trials Registry and Medline with the content terms tonsillitis, pharyngitis, and sore throat.
Trials published in any language were selected if they assessed a non-antibiotic intervention, and outcomes included patient reported sore throat symptoms.
Data were extracted on the treatment, definition of illness, patient characteristics, study setting, blinding, and estimate of relative treatment effect (compared with control). Each symptom was assigned a score on the same scale (with a score of 100 assigned at baseline). Main outcome was percentage change in symptom score in intervention group compared with the control group.
22 studies were included in the analysis; 7 included an antibiotic treatment and 2 evaluated vaccinations to prevent sore throat episodes. The table ⇓shows study results for the remaining 13 studies of non-antibiotic treatment. Studies could not be meta-analysed because of heterogeneity.
Non-steroidal anti-inflammatory drugs, paracetamol, and analgesic/anti-inflammatory oral rinse are more effective than placebo for reducing acute sore throat symptoms.
This systematic review by Thomas et al consolidates the research comparing pharmacological, non-antibiotic interventions with placebo for the treatment of acute sore throat. A previous meta-analysis by the same authors found that antibiotics offer a small reduction in duration and complications related to sore throat, compared with placebo or no treatment.1 Many of the alternative treatments to antibiotics had larger effect sizes than antibiotics; the authors acknowledge, however, an absence of data comparing these alternatives directly with antibiotics. In addition, the trials included in this review did not seem to address potential side effects, drug interactions, allergies, contraindications, and other complications of the non-antibiotic treatments.
Strengths of this review include the focus on randomised controlled trials, the exclusion of studies with excessive dropouts and unclear randomisation and blinding, and the inclusion of trials written in any language. Unpublished studies were not included which, as the authors note, can lead to publication bias and exaggerated treatment effects.
The finding that non-antibiotic interventions reduce sore throat symptoms better than placebo has implications for client education done by nurses and physicians in the primary care setting; that is, practitioners can promote client empowerment by encouraging self care for sore throats.
Future research may focus on obtaining information that compares the effects of various dosing amounts, timing, and duration of the pharmacological methods described.
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 Medicine.
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