What is the recommended steroid dosing for laryngitis?

Steroid Dosing for Laryngitis

Steroids should not be routinely prescribed for laryngitis prior to visualization of the larynx due to limited evidence of benefit and significant potential risks. 1

When to Consider Steroids for Laryngitis

Steroids should only be used in specific circumstances:

1. After laryngoscopic examination to confirm diagnosis
2. For severe cases with airway compromise
3. For professional voice users after shared decision-making
4. For specific types of laryngitis:
   • Subglottic laryngitis (pseudocroup)
   • Epiglottitis (supraglottic laryngitis)
   • Post-extubation stridor

Recommended Dosing When Indicated

For Adults:

• Dexamethasone: 0.3-0.6 mg/kg IV or oral as a single dose 1, 2
• Prednisone: 1 mg/kg/day (maximum 60 mg) as a single daily dose for 5-10 days 1
• Methylprednisolone: 48 mg/day (equivalent to prednisone 60 mg) 1

For Children with Croup/Subglottic Laryngitis:

• Dexamethasone: 0.6 mg/kg oral or IM as a single dose 2, 3
• Budesonide: 2000 micrograms via jet nebulizer for moderate to severe cases 3

For Post-Extubation Stridor:

• Dexamethasone: >0.3 mg/kg IV, continued for at least 48 hours 4

Important Considerations

Risks and Side Effects

Steroid therapy carries significant risks including:

• Hyperglycemia and weight gain
• Increased risk of infection
• Mood disturbances
• Hypertension
• Gastrointestinal bleeding
• Adrenal suppression
• Avascular necrosis with prolonged use 1

Duration of Treatment

• For acute laryngitis: Single dose or short course (5-10 days)
• For post-extubation stridor: At least 48 hours 4
• Tapering is not necessary for short courses 1

Contraindications and Precautions

• Avoid high-dose steroids (e.g., hydrocortisone >300 mg/day) 1
• Use with caution in patients with diabetes, hypertension, or history of peptic ulcer disease
• Consider potential drug interactions

Alternative Treatments

1. Voice rest and hydration
2. Humidification
3. Avoidance of irritants (smoking, alcohol)
4. Throat lozenges or warm liquids for symptomatic relief 4

Special Considerations

Professional Voice Users

For professional voice users, a shared decision-making approach is recommended after discussing the limited evidence for benefit and potential risks of steroid therapy 1.

Bacterial vs. Viral Laryngitis

• Viral laryngitis (most common): Steroids may provide symptomatic relief but antibiotics are not indicated
• Bacterial epiglottitis: Requires antibiotics in combination with corticosteroids 5

Common Pitfalls

1. Using steroids empirically without laryngoscopic examination
2. Underdosing steroids when they are actually indicated
3. Using methylprednisolone dose packs which provide inadequate total dosing (equivalent to only 105 mg prednisone over 6 days) 1
4. Prescribing antibiotics for viral laryngitis, which is ineffective and contributes to antibiotic resistance 1

Remember that most cases of acute laryngitis are self-limiting and will resolve within 7-10 days regardless of treatment. The risks of steroid therapy often outweigh the benefits in mild cases.