Adjuvant prednisone therapy in pharyngitis: a randomised controlled trial from general practice.

BACKGROUND: Acute pharyngitis is a frequent and well-documented complaint in general practice but the associated suffering has remained largely unaddressed in the literature. Evidence, however, from five randomised controlled trials suggests that corticosteroids may be useful in relieving pain and discomfort arising from the condition. AIM: To determine if short-acting oral therapy with prednisone was more effective than placebo in alleviating the suffering from acute pharyngitis in adults in a general practice setting. DESIGN OF STUDY: Randomised placebo-controlled trial. SETTING: General practice in Israel. METHOD: Patients with acute pharyngitis were randomised to receive 60 mg prednisone orally for 1 or 2 days, or identical placebo treatment. The main outcome measures were throat pain, measured by a visual analogue scale at 12, 24, 48 and 72 hours after presentation, time off work, fever, dysphagia, recurrence of symptoms and bacterial recurrence. RESULTS: Patients treated with prednisone experienced more rapid throat pain resolution than those in the placebo group. No adverse effects were reported nor any differences between the two groups regarding either symptom or positive bacterial culture recurrence. CONCLUSION: Short-acting oral steroid therapy is effective for shortening throat pain duration in acute pharyngitis.

How successfully do general practitioners diagnose herpetic gingivo-stomatitis clinically?

Herpetic gingivo-stomatitis is a common, often painful affliction of young children. Recently, aciclovir treatment has been found to be effective in hospital-referred cases, an approach limited in general practice where laboratory diagnosis is invariably impractical. This study demonstrated that 49 out of 63 clinical diagnoses of herpetic gingivo-stomatitis [PPV = 78%] made by 27 GPs were subsequently validated by laboratory virus culture. This suggests that herpetic gingivo-stomatitis might be treated with aciclovir in general practice on the basis of a clinical diagnosis alone.