What is the efficacy of corticosteroids and antipyretics in the treatment of group A beta-hemolytic streptococcal (GABHS) pediatric pharyngitis?

Updated: Dec 11, 2018
  • Author: Harold K Simon, MD, MBA; Chief Editor: Russell W Steele, MD  more...
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Answer

Corticosteroids (eg, dexamethasone) have been suggested as adjunctive therapy to decrease pain and shorten symptom duration in adults with pharyngitis. A study in children found that a single dose of oral dexamethasone (0.6 mg/kg, not to exceed 10 mg) did not decrease time to onset of clinically significant pain relief or time to complete pain relief. [11] However, in those children with positive rapid streptococcal test results, there was a statistically significant (but only marginally clinically significant) reduction in time to onset of pain relief.

Therefore, the use of steroids is not routinely recommended but can be considered. This position is also supported by a systematic review of pharyngitis in adult patients, which reported a slight decrease in time to resolution and amount of pain concluded that in view of the heterogeneity of the results, the use of steroids was not routinely recommended but could be offered for consideration on a patient-by-patient basis. [17]

In addition to adequate antibiotic therapy for patients with GABHS, administer antipyretics for pain and fever in all patients, regardless of whether the cause is bacterial or viral. Ibuprofen (10 mg/kg orally every 8 hours) or acetaminophen (15 mg/kg orally every 4-6 hours) is effective. Any such over-the-counter medications should be taken on a limited basis for a limited time (≤ 2-3 days), in accordance with package insert instructions and recommendations for dosing, delivery, and use; any questions or concerns should be referred to the primary care provider.

For patients with herpangina (stomatitis or pharyngitis), alumina-magnesia mixed with diphenhydramine hydrochloride in a 1:1 ratio can be administered orally before meals to decrease associated discomfort and to help maintain good hydration. This medication can be dosed on the basis of the diphenhydramine component (1.25 mg/kg oral swish and swallow every 6 hours as needed).


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