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TOAST study reaches recruitment target

26 February 2015

The Treatment Options without Antibiotics for Sore Throat (TOAST) project, a collaborative study organised through the University of Oxford, the University of Southampton and the Centre for Academic Primary Care at the University of Bristol, has reached its initial recruitment target of 566 randomized patients across 40 practices on time.

Almost one in 10 registered patients will see their GP every year with sore throat. Sore throat is estimated to cost £430 million annually in consultations and lost productivity alone.

91% of those diagnosed with tonsillitis will receive antibiotics, as will half of those recorded as 'sore throat' or 'pharyngitis'. NICE guidance recognises the limited evidence for benefit of antibiotics in its advice to avoid prescriptions in most patients. However, prescribing rates remain disproportionately high. An alternative symptomatic treatment could reduce both unnecessary antibiotic prescribing and the economic burden of sore throat.

In a BMJ systematic review, researchers say that patients with sore throat receiving a single dose of steroids were three times more likely to experience complete resolution of pain at 24 hours and experienced pain relief six hours earlier. However, all of the patients received antibiotics, and few were recruited from primary care.

The team proposes a randomised, placebo controlled, blinded trial design in patients aged between 18 and 70 years presenting to the GP with acute sore throat. Patients will receive a single dose of either oral dexamethasone (10mg) or identical placebo. Patients, clinicians and researchers will be blinded. Where an antibiotic is indicated according to NICE guidance, a delayed prescription will be provided.

Julie Allen, TOAST trial manager said: “This has been a real team effort and a target which would not have been achieved without the commitment from our recruiting practices over the last two years and all of the coordinators at our collaborating centres. We’re looking forward to seeing the results later in the year!"

The team has an international reputation in respiratory infection research, with previous successful clinical trials in this area and collaborations with School partners on a relevant trial (OSAC trial).

Further information

More information about antbiotics research at the Centre for Academic Primary Care, Bristol

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