Background: Acute pharyngitis (AP) is a common presentation to the Emergency Department (ED).
Most AP patients' who present to the ED are interested in relief their sore throat (pain).
There are different approaches available in the literature to control AP pain. Studies have
shown that the use of systemic glucocorticoids significantly decreases patients' sore throat.
Up to our knowledge, there are no available trials looking at the role of nebulized
glucocorticoids in treating infective AP.
Aim: Our aim is to investigate in pediatrics and adults population ≥5 years presenting to ED
with AP if the use of a single dose of nebulized glucocorticoids as an adjunct to standard AP
treatment, compared with placebo leads to complete resolution or improvement in symptoms.
Method: The investigators are planning to conduct a multi-center, double-blind randomized
control trial. There will be three arms; first arm: nebulized Budesonide, second arm:
nebulized Dexamethasone and third arm: placebo nebulized Normal Saline (NS). The patients
will be followed up for 15 days through phone calls to assess the primary and secondary
outcomes. Our primary objective is to investigate whether the use of a single dose of
nebulized glucocorticoids compared with placebo leads to significant improvement or complete
resolution of the sore throat within 24hrs. Our secondary objectives are to assess if a
single dose of glucocorticoids will: reduce sore throat at 48 hours, reduce absence from work
or school, reduce the incidence of hospital admission, and reduce the rate of re-attendance
to ED. Since there is no available data about the effect of nebulized glucocorticoids in AP,
the appropriate sample size will be calculated after running a pilot study. The data will be
recorded in the EpiData@ software. Then the data will be analyzed using the SPSS@ software.
The ethical approval was sought from the ethical committee in each participating hospital and
they approved it.
Results: The result of this study will be presented in local conferences as well in
international conferences. The investigators will aim to publish the study in a well-known
international emergency medicine journal.
Clinical application: up to our knowledge this study is the first study worldwide looking at
the effect of nebulized glucocorticoids in patients with infective acute pharyngitis. As
mentioned earlier that there are multiple approaches available in the literature to control
sore throat pain and if our hypothesis turned to be correct then another alternative
treatment can be added. The investigators believe that the use of topical route to administer
glucocorticoids is more convenient for physicians and have less chance to develop adverse
effect in comparison to systemic steroids.