What is the recommended dose of prednisone (corticosteroid) for tonsillar swelling?

Prednisone Dosing for Tonsillar Swelling

For tonsillar swelling, a recommended dose of prednisone is 1 mg/kg/day (maximum 60 mg daily) for 7-14 days, followed by a gradual taper over a similar time period. 1, 2

Dosing Considerations

Initial Dosing

• Severe tonsillar swelling: 1 mg/kg/day (maximum 60 mg daily)
• Moderate tonsillar swelling: 0.5-0.75 mg/kg/day
• Mild tonsillar swelling: 0.3-0.5 mg/kg/day

Administration

• Take in the morning before 9 am to minimize adrenal suppression 2
• Take with food or milk to reduce gastric irritation 2
• Single daily dose is preferred over divided doses for short-term therapy 2

Duration and Tapering

• Initial treatment: Full dose for 7-14 days 1
• Tapering: Gradual reduction over a similar time period to prevent adrenal insufficiency 1, 2
• Tapering schedule:
  • Reduce by one-third or one-quarter down to 15 mg daily
  • Then by 2.5 mg decrements to 10 mg daily
  • Then by 1 mg monthly if longer therapy is needed 1

Special Considerations

Intraoperative Use

• For patients undergoing tonsillectomy, a single intraoperative dose of intravenous dexamethasone (0.5 mg/kg, with doses ranging from 0.15-1.0 mg/kg) is strongly recommended 3
• Benefits include:
  • Decreased post-operative nausea and vomiting
  • Decreased throat pain
  • Decreased time to resumption of oral intake
  • Lower pain scores 3

Monitoring

• Monitor for common side effects:
  • Insomnia
  • Mood changes
  • Increased appetite 4
• For longer courses, monitor:
  • Blood pressure
  • Blood glucose
  • Signs of infection 1

Contraindications and Cautions

• Contraindications:

  • Active untreated infections
  • Patients already receiving exogenous steroids
  • Patients with endocrine disorders where steroid administration may interfere with glucose-insulin regulation 3

• Cautions:

  • Never stop prednisone abruptly due to risk of adrenal insufficiency 1
  • Use with caution in patients with diabetes, hypertension, or glaucoma 1

Clinical Pearls

• The anti-inflammatory effect of corticosteroids is believed to reduce swelling through their potent anti-inflammatory properties 3
• Early treatment with adequate dosing is crucial for optimal outcomes 3
• Avoid underdosing, as inadequate anti-inflammatory effect may lead to persistent symptoms 1
• Corticosteroids should be used as part of a comprehensive treatment plan, which may include appropriate antimicrobial therapy if bacterial infection is suspected