What is the recommended dosage of prednisone (corticosteroid) for treating sinus issues?

Prednisone Dosage for Sinus Conditions

For sinus conditions, a short course of oral prednisone at 25-60 mg daily for 7-21 days is recommended, with the specific dosage depending on the severity and type of sinus issue being treated. 1

Dosage Recommendations by Sinus Condition Type

For Acute Post-Viral Rhinosinusitis:

• The European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) 2020 guideline advises against the use of systemic corticosteroids for acute post-viral rhinosinusitis due to limited evidence of long-term benefit and potential harm 2
• While there may be a small but significant effect on facial pain at days 4-7, systemic corticosteroids do not have a positive effect on recovery at 7-14 days 2

For Chronic Rhinosinusitis with Nasal Polyps (CRSwNP):

• Recommended dosage: 25-60 mg of prednisone daily for 7-21 days 1
• Alternative tapering schedule: methylprednisolone 32 mg/day for days 1-5,16 mg/day for days 6-10,8 mg/day for days 11-20 1
• A short course (5-7 days) is appropriate for very severe or intractable rhinitis or nasal polyposis 2

For Chronic Rhinosinusitis without Nasal Polyps (CRSsNP):

• Prednisolone at 0.5 mg/kg tapered over 10 days has shown significant improvement in symptoms, nasal endoscopy, and sinus CT scan scores 3
• Most beneficial for patients with symptoms less than 11 months in duration 3

Administration Guidelines

• Take prednisone in the morning before 9 am to minimize adrenal suppression 4
• Take with food or milk to reduce gastric irritation 4
• For courses less than 1 week, gradual dose reduction is not necessary 1
• For courses up to 10 days, tapering is probably not necessary 1
• For longer courses, taper by decreasing the initial dose in small increments at appropriate intervals 4

Expected Outcomes

• Effects on olfaction (sense of smell) are often seen within days, even before visible changes in polyp volume 1
• For CRSwNP, oral corticosteroids can reduce symptoms and polyp size and improve nasal flow 2
• For CRSsNP, 52.5% of patients treated with prednisolone avoided surgical intervention in the first 12 months compared to 14.3% of controls 3

Important Cautions

• Limit systemic corticosteroid use to 1-2 courses per year for patients with partially or uncontrolled disease 1
• Single administration of parenteral corticosteroids is discouraged, and recurrent administration is contraindicated 2
• Short-term adverse effects include insomnia, nervousness, increased appetite, mood changes, glucose intolerance, and dyspepsia 1
• Side effects were reported in 8.9% of prednisolone-treated patients in one study 3
• Consider maintenance with intranasal corticosteroids between systemic courses for long-term management 1

Follow-up Recommendations

• Evaluate treatment response with repeat olfactory function testing 2-4 weeks after starting treatment 1
• For nasal polyps, consider intranasal corticosteroids after oral treatment to maintain benefits 5
• Monitor for recurrence, which tends to occur within five months after successful oral steroid therapy 5

Intranasal corticosteroids should be considered as the primary ongoing treatment for most sinus conditions, with oral prednisone reserved for severe exacerbations or as preparation for surgery 2, 5.