TOAST: Treatment Options without Antibiotics for Sore Throat

Every year, nearly one in 10 patients registered with a GP will have a consultation for sore throat, a condition associated with a yearly estimated cost of £400 million in consultations and lost productivity alone.  Almost all patients diagnosed with tonsillitis will receive antibiotics, as will half of those simply recorded as having a sore throat. Research shows that antibiotics offer limited benefit for symptoms of sore throat, and national guidance now recommends that in most people, they should not be prescribed.  Clearly, high rates of unnecessary antibiotic prescribing are occurring for sore throat in the UK, and this contributes to the development of antibiotic-resistant bacterial strains.

In practice, reducing unnecessary antibiotic prescribing will be easier if the clinician can offer an alternative option for symptom relief. We have recently performed a systematic review of trials assessing whether a one-off dose of oral steroids can reduce the swelling and therefore the pain of sore throat. We found that a one-off dose of steroids meant that a patient was 3 times more likely to have resolution of sore throat symptoms the next day. However, in these trials the patients received antibiotics as well as steroids. We now aim to test whether steroids alone, without antibiotics, can improve the symptoms of sore throat.

We plan to recruit 510 adult patients with sore throat from GP practices in the UK. Patients will receive a single dose of either steroid or placebo tablets. GPs will prescribe antibiotics according to national guidelines, but as a delayed prescription for the patient to ‘cash’ if they need it. We will assess the safety and success of the treatment by asking the patients to report on whether their symptoms have completely resolved at 24 and 48 hours, and also to complete a diary of symptoms and adverse events over 14 days. We will see if steroids helped to reduce the use of delayed antibiotic prescriptions and costs to the NHS.

TOAST is led by Dr Matthew Thompson at the University of Oxford with additional recruitment Centres led by Dr Alastair Hay at the University of Bristol and Dr Michael Moore at the University of Southampton.

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