What is the recommended steroid dose for tonsillitis?

Steroid Dose for Tonsillitis

For acute tonsillitis in children and adults, administer a single intraoperative or perioperative dose of intravenous dexamethasone at 0.15-0.6 mg/kg (maximum 10 mg) to reduce pain and improve recovery. 1

Recommended Dosing Protocol

For Perioperative Use (Tonsillectomy Context)

• Single dose of IV dexamethasone: 0.15-0.6 mg/kg (most studies used 0.5 mg/kg), with a maximum dose of 8-10 mg 1
• Administer intraoperatively as a one-time dose 1
• This dosing provides strong evidence for reducing postoperative nausea/vomiting (PONV), decreasing pain scores, and shortening time to first oral intake 1

For Acute Tonsillitis (Non-Surgical Context)

• Single dose of oral or intramuscular dexamethasone: 0.6 mg/kg for symptom relief 2
• Alternative: Oral dexamethasone up to 10 mg as a single dose in adults with sore throat 3
• This provides moderate pain relief at 24 hours and increases likelihood of complete pain resolution at 48 hours 3

Clinical Benefits Supported by Evidence

Pain reduction: Patients receiving single-dose corticosteroids experience pain relief 4.8 hours earlier than placebo, with absolute pain reduction of 1.3 points on a 0-10 visual analog scale at 24 hours 3

Improved oral intake: Dexamethasone decreases time to first oral intake after tonsillectomy, which is particularly beneficial when electrosurgery is used 1

PONV prevention: Single intraoperative dose reduces postoperative nausea and vomiting up to 24 hours post-procedure 1

Safety Considerations and Contraindications

Exclude patients with:

• Endocrine disorders already receiving exogenous steroids 1
• Diabetes or conditions where steroid administration may interfere with glucose-insulin regulation 1
• Known coagulopathy or bleeding disorders (though steroids themselves don't increase bleeding risk) 1

Adverse events: Multiple systematic reviews and randomized controlled trials show no increase in postoperative bleeding with perioperative dexamethasone, even at increasing doses 1, 3

Short-term safety: Single-dose and short-course steroid therapy (less than one week) have acceptable safety profiles, though rare complications like chickenpox exacerbation and avascular necrosis of the femoral head remain theoretical risks 2

Important Clinical Caveats

Timing matters: For acute tonsillitis without surgery, steroids provide moderate efficacy but have not been compared head-to-head with standard analgesics like paracetamol in most studies 2

Not for routine ENT infections: There are no published data justifying routine steroid use in non-allergic rhinitis, sinusitis, or otitis 2

Avoid chronic use: Routine steroids for recurrent ENT infections carry the same risks as long-term steroid therapy and should be avoided 2

Antibiotic therapy remains primary: Acute bacterial tonsillitis should be treated with beta-lactam antibiotics (penicillin or cefuroxime) alongside NSAIDs and steroids 4

Practical Implementation

For tonsillectomy patients: Administer dexamethasone 0.5 mg/kg IV (max 10 mg) as a single intraoperative dose 1

For acute pharyngitis/tonsillitis in outpatient settings: Consider single-dose oral dexamethasone 10 mg (or 0.6 mg/kg in children) to hasten symptom relief, particularly in patients with severe pain 3

Do not taper: When used as a single dose or short course (up to 2 weeks), oral steroids can be stopped from full dosage without tapering 1