Corticosteroids in peritonsillar abscess treatment: A blinded placebo-controlled clinical trial

Authors

  • Jason K. M. Chau MD, MPH,

    Corresponding author
    1. Department of Otolaryngology, University of Manitoba, Winnipeg, Manitoba, Canada
    • Send correspondence to Dr. Jason K. M. Chau, Department of Otolaryngology, University of Manitoba, GB421 Health Sciences Center, 820 Sherbrook Street, Winnipeg, Manitoba, Canada R3A 1R9. E-mail: jason.chau@yahoo.ca

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  • Hadi R. Seikaly MD, FRCSC,

    1. Department of Surgery, Division of Otolaryngology–Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada
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  • Jeffery R. Harris MD, FRCSC,

    1. Department of Surgery, Division of Otolaryngology–Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada
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  • Cristina Villa-Roel MD, MSc,

    1. Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
    2. School of Public Health, University of Alberta, Alberta, Canada
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  • Craig Brick BSc,

    1. Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
    2. University College Cork, Cork, Ireland
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  • Brian H. Rowe MD, MSc

    1. Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
    2. School of Public Health, University of Alberta, Alberta, Canada
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  • Presented at the 66th Annual Meeting of the Canadian Society of Otolaryngology–Head & Neck Surgery, Toronto, Ontario, Canada, May 20–22, 2012.

  • The authors have no other funding, financial relationships, or conflicts of interest to disclose.

  • Funding support for this project was generously provided by the University Hospital Foundation and the Department of Emergency Medicine Research Group at the University of Alberta (c.v.-r., c.b.). c.v.-r. is supported by the Canadian Institutes of Health Research (CIHR) in partnership with the Knowledge Translation branch. b.h.r. is supported by the CIHR as Tier I Canada Research Chair in Evidence-Based Emergency Medicine (Government of Canada).

Abstract

Objectives/Hypothesis

Sore throat is a common, benign emergency department (ED) presentation; however, peritonsillar abscess (PTA) is a complication that requires aggressive management. Use of systemic corticosteroids (SCSs) in PTA is occurring without clear evidence of benefit. This study examined the efficacy and safety of SCS treatment for patients with PTA.

Study Design

Randomized, double-blind, placebo-controlled trial.

Methods

A controlled trial with concealed allocation and double-blinding was conducted at two Canadian EDs. Following written informed consent, eligible patients received 48 hours of intravenous clindamycin and a single dose of the study drug (dexamethasone [DEX] or placebo [PLAC], intravenously [IV]). Follow-up occurred at 24 hours, 48 hours, and 7 days. The primary outcome was pain; other outcomes were side effects and return to normal activities/diet.

Results

A total of 182 patients were screened for eligibility; 41 patients were enrolled (21 DEX; 20 PLAC). At 24 hours, those receiving DEX reported lower pain scores (1.4 vs. 5.1; P = .009); however, these differences disappeared by 48 hours (P = .22) and 7 days (P = .4). At 24 hours, more patients receiving DEX returned to normal activities (33% vs. 11%) and dietary intake (38% vs 25%); however, these differences were not significant and disappeared by 48 hours and 7 days. Side effects were rare and did not differ between groups (P > .05).

Conclusions

Combined with PTA drainage and IV antibiotics, 10 mg IV DEX resulted in less pain at 24 hours when compared to PLAC, without any serious side effects. This effect is short-lived, and further research is required on factors associated with PTA treatment success.

Level of Evidence

1b Laryngoscope, 124:97–103, 2014

Ancillary