Antibiotic Treatment in Bell's Palsy

Antibiotics are not recommended for the treatment of Bell's palsy as there is no evidence supporting their efficacy. 1

First-Line Treatment Recommendations

Oral corticosteroids are the primary evidence-based treatment for Bell's palsy and should be prescribed within 72 hours of symptom onset for patients 16 years and older 1, 2
The recommended corticosteroid regimen is prednisolone 50 mg daily for 10 days or prednisone 60 mg daily for 5 days followed by a 5-day taper 1
Corticosteroid treatment significantly improves facial nerve recovery, with studies showing 83% recovery at 3 months with prednisolone versus 63.6% with placebo 1, 3
Long-term outcomes are also improved with corticosteroids, with 94.4% recovery at 9 months with prednisolone versus 81.6% with placebo 1, 3

Antiviral therapy alone should not be prescribed for Bell's palsy 1, 4
Combination therapy with oral antivirals and corticosteroids may be offered within 72 hours of symptom onset as an option 1, 4
Antivirals plus corticosteroids may reduce long-term sequelae such as motor synkinesis compared to corticosteroids alone 4
Common antiviral options include valacyclovir (1 g three times daily for 7 days) or acyclovir (400 mg five times daily for 10 days) 2

Bell's palsy is an idiopathic condition, though viral reactivation (particularly herpes simplex virus) is the most widely accepted theory 1, 5
While some researchers have hypothesized potential bacterial involvement in certain cases of Bell's palsy 6, this theory lacks substantial evidence and is not supported by current clinical guidelines 1
The pathomechanism involves inflammation and entrapment of the facial nerve in the bony foramen 6

Bell's palsy is diagnosed through careful elimination of other causes, with a thorough history and physical examination 1
Routine laboratory testing and diagnostic imaging are not recommended for initial diagnosis 1
Eye protection is essential for patients with impaired eye closure to prevent corneal damage 1
Patients should be reassessed or referred to a specialist if they have new or worsening neurologic findings, ocular symptoms, or incomplete facial recovery after 3 months 1

Children with Bell's palsy have better prognosis with higher rates of spontaneous recovery 1
Pregnant women should be treated with oral corticosteroids within 72 hours of symptom onset, with careful consideration of benefits and risks 1
For both children and pregnant women, the rate of complete spontaneous recovery can be up to 90% 2

Delaying corticosteroid treatment beyond 72 hours reduces effectiveness 1
Using antiviral therapy alone is ineffective and not recommended 1, 4
Prescribing antibiotics for Bell's palsy is not supported by evidence and should be avoided 1
Failing to provide adequate eye protection for patients with impaired eye closure can lead to corneal damage 1