In Reply Dr Sardovski highlights a recent population cohort study1 suggesting an increased risk of adverse events with short courses of oral corticosteroids. Although the risks of sepsis, fracture, and venous thromboembolism were less pronounced in those patients prescribed corticosteroids for respiratory conditions than musculoskeletal conditions, we agree that these data need to be taken into account when physicians are considering the risks and benefits of prescribing corticosteroids for sore throat. The small increase in the chance of complete resolution at 48 hours demonstrated in our trial has to be balanced not only against the potential adverse effects of steroids but also against the lack of significant benefit seen in resolution at 24 hours, overall symptom burden, time off of work, and use of a delayed antibiotic prescription.
Hayward GN, Moore MV, Heneghan C. Dexamethasone Without Antibiotics for Sore Throat—Reply. JAMA. 2017;318(8):753–754. doi:10.1001/jama.2017.8671