Is prednisolone (corticosteroid) effective for treating swollen tonsils?

Prednisolone for Swollen Tonsils

Prednisolone is not recommended as a routine treatment for swollen tonsils (tonsillitis) unless specific indications are present. Short courses of systemic corticosteroids should be reserved for special circumstances such as severe airway obstruction, professional voice users with confirmed allergic laryngitis, or as an adjunct to antibiotics in severe cases 1.

Evidence for Prednisolone Use in Tonsillitis

• Acute tonsillitis is typically self-limited, with most patients experiencing improvement within 7-10 days regardless of treatment 1, 2
• The American Academy of Otolaryngology-Head and Neck Surgery recommends against empirically prescribing corticosteroids for throat conditions before visualization of the larynx 1
• Systemic corticosteroids can cause significant adverse effects including immunosuppression, metabolic changes, and cardiovascular risks 1

Specific Situations Where Prednisolone May Be Considered

• Severe tonsillar inflammation with airway compromise: In cases where significant swelling threatens airway patency 1
• Nasal polyps: Short courses of oral prednisone (25-60mg for 7-20 days) have shown significant reduction in symptoms and polyp size in the short term (2-4 weeks) 3
• Post-tonsillectomy: Evidence does not support routine use of prednisolone for post-tonsillectomy pain management in children 4, 5

Treatment Algorithm for Swollen Tonsils

1. First-line treatment: Supportive care with adequate hydration and analgesia (ibuprofen or paracetamol) 3, 2

2. Antimicrobial therapy: Consider only if bacterial infection is suspected (e.g., Group A Streptococcus) 2, 6

3. Consider prednisolone only if:

   • Severe inflammation with risk of airway compromise 1
   • Professional voice user with confirmed allergic laryngitis 1
   • Part of management for specific conditions like infectious mononucleosis with significant tonsillar hypertrophy 7

Dosing Considerations (If Indicated)

• For adults with severe symptoms: Prednisolone 25-60mg daily for 5-7 days 3
• Taper dose gradually to minimize adverse effects 1
• The lowest effective dose should be used for the shortest duration necessary 1

Important Caveats and Risks

• Systemic corticosteroids carry significant risks including:

  • Cardiovascular: hypertension and cardiovascular disease 1
  • Metabolic: diabetogenesis and weight gain 1
  • Musculoskeletal: osteoporosis and avascular necrosis 1
  • Increased risk of infection 1

• Short-term courses of systemic corticosteroids are generally safe but can cause insomnia, mood changes, and gastrointestinal disturbances 3

• Empiric use of steroids without proper evaluation may delay appropriate diagnosis and treatment 1

• The risk-benefit ratio must be carefully considered in each case, as the evidence for benefit in tonsillitis is limited while risks are well-documented 1