What is the recommended dose of dexamethasone (corticosteroid) for acute tonsillitis?

Dexamethasone Dosing for Acute Tonsillitis

For acute tonsillitis (non-surgical), a single dose of oral dexamethasone 10 mg provides significant pain relief and reduces time to symptom resolution, with no increased risk of adverse effects. 1

Evidence for Dexamethasone in Acute Tonsillitis

Efficacy for Pain Relief

• Patients receiving a single low-dose corticosteroid (maximum 10 mg oral dexamethasone) are twice as likely to experience pain relief at 24 hours (relative risk 2.2,95% CI 1.2-4.3) and 1.5 times more likely to have complete pain resolution at 48 hours compared to placebo. 1

• The mean time to onset of pain relief is 4.8 hours earlier in patients treated with corticosteroids compared to placebo, and complete pain resolution occurs 11.1 hours earlier. 1

• Absolute pain reduction at 24 hours is clinically meaningful, with a mean difference of 1.3 points on a 0-10 visual analog scale. 1

Recommended Dosing

• The standard dose for acute tonsillitis/pharyngitis is oral dexamethasone 10 mg as a single dose, which represents the most commonly studied and effective intervention. 1

• This dosing applies to patients aged 5 years and older presenting with clinical signs of acute tonsillitis or pharyngitis in emergency department or primary care settings. 1

Safety Profile

• Nine of 10 trials specifically assessed adverse events, with six reporting no adverse effects and three reporting minimal complications related to the underlying disease rather than the medication. 1

• There is no evidence of increased serious adverse effects with single low-dose corticosteroid administration for acute sore throat. 1

Important Clinical Caveats

Distinction from Surgical Tonsillectomy

The question asks about acute tonsillitis (medical condition), not tonsillectomy (surgical procedure). For perioperative tonsillectomy, different dosing applies: 0.15 mg/kg in children (maximum 8-25 mg) or 8 mg in adults for postoperative nausea/vomiting and pain control. 2

Recurrent Episodes

• The included trials did not assess potential risks of larger cumulative doses in patients with recurrent episodes of acute sore throat. 1 Exercise caution with repeated dosing in patients with frequent recurrences.

Timing Considerations

• Dexamethasone should be administered as an adjunct to standard care (typically antibiotics if bacterial infection is suspected) rather than as monotherapy. 1

• The benefit is most pronounced when given early in the disease course. 1