What is the treatment protocol for a sore throat using prednisone (corticosteroid) 10 mg?

Prednisone Treatment Protocol for Sore Throat

Prednisone 10 mg is not recommended as a routine treatment for sore throat but may be considered as a single dose in adults with severe presentations (Centor score 3-4) in conjunction with appropriate antibiotic therapy. 1

First-Line Treatment Recommendations

• Either ibuprofen or paracetamol (acetaminophen) should be used as first-line treatment for relief of acute sore throat symptoms 2
• Antibiotics should not be used in patients with less severe presentation of sore throat (0-2 Centor criteria) 2
• If antibiotics are indicated (based on 3-4 Centor criteria), penicillin V twice or three times daily for 10 days is recommended 2

Corticosteroid Use in Sore Throat

• Corticosteroids may provide modest benefit in adults with severe sore throat (Centor score 3-4) when used alongside antibiotic therapy 1, 3
• A single oral dose of corticosteroid can increase the likelihood of complete resolution of pain at 24 hours (RR 2.4) and at 48 hours (RR 1.50) 3
• The effect of steroids appears smaller when administered orally compared to other routes and may be considerably smaller in typical primary care populations where most patients do not have severe presentations 1
• No significant benefit has been demonstrated in children with sore throat 1

Prednisone Dosing Considerations

• If using prednisone, a single dose of 10 mg is likely insufficient based on available evidence 4, 5
• Studies showing benefit typically used higher doses:
  • Single oral dose of dexamethasone 10 mg (equivalent to approximately 60-70 mg prednisone) 5
  • Prednisone 60 mg for 1-2 days has shown benefit in reducing throat pain duration 4
• Prednisone should be administered in the morning prior to 9 am to minimize adrenal suppression 6
• Taking prednisone with food or milk may reduce gastric irritation 6

Important Clinical Considerations

• The modest benefits of corticosteroids must be weighed against potential side effects, though short-term use appears to have minimal adverse effects 3, 1
• Five people need to be treated with corticosteroids to prevent one person continuing to experience pain at 24 hours 3
• Zinc gluconate is not recommended for use in sore throat 2, 1
• Local anesthetics (lidocaine, benzocaine, ambroxol) can be recommended as symptomatic treatment 7
• If using corticosteroids, they should be considered as an adjunct to standard therapy rather than a replacement 1, 3

Cautions and Contraindications

• Corticosteroids should not be used routinely for all cases of sore throat 1
• Avoid prescribing steroids for hoarseness or dysphonia without proper evaluation 1
• If prescribing prednisone, be aware that abrupt withdrawal should be avoided, though this is less concerning with short-term use 6
• The benefit-risk profile for corticosteroid use is most favorable in adults with severe symptoms who have no contraindications to short-term steroid use 1, 3