What is the recommended dosage and duration of prednisone for treating bronchitis and sinusitis?

Prednisone Dosing for Bronchitis and Sinusitis

For acute bronchitis (COPD exacerbation), use prednisone 40 mg daily for 5 days; for acute sinusitis, use prednisone 30 mg daily for 7 days as adjunctive therapy to antibiotics. 1, 2

Bronchitis (COPD Exacerbation)

The GOLD guidelines establish prednisone 40 mg daily for 5 days as the standard regimen for acute COPD exacerbations. 1

• This dosing shortens recovery time, improves FEV1 and oxygenation, and reduces the risk of early relapse and treatment failure 1
• Oral prednisone is equally effective to intravenous administration 1
• Duration should not exceed 5-7 days to minimize adverse effects 1
• Combine with short-acting bronchodilators (beta-agonists with or without anticholinergics) as first-line therapy 1

Important Caveats for Bronchitis Treatment

• Glucocorticoids may be less effective in patients with lower blood eosinophil levels 1
• For postinfectious cough persisting after acute respiratory infection, consider 30-40 mg prednisone daily for a short course only when other causes (upper airway cough syndrome, asthma, GERD) have been ruled out 1
• Antibiotics should be added when there is increased sputum purulence, increased dyspnea, and increased sputum volume (three cardinal symptoms) 1

Sinusitis

For acute bacterial sinusitis, prednisone 30 mg daily for 7 days provides modest short-term symptom relief when used as adjunctive therapy to antibiotics. 2

• This regimen shows resolution of facial pain in 4-7 days with a risk ratio of 1.17 (95% CI 1.05-1.30), meaning 11% more patients improve compared to placebo 2
• The benefit is not sustained beyond 10-14 days after treatment initiation 2
• Nearly two-thirds of patients improve with placebo alone, making the absolute benefit small 2

Chronic Rhinosinusitis Dosing

For chronic rhinosinusitis with nasal polyps, use prednisone 25 mg daily for 2 weeks followed by intranasal corticosteroids for maintenance. 2, 1

• This regimen provides greater improvement in symptoms, polyp scores, and quality of life compared to intranasal corticosteroids alone 2, 1
• Improvements in sense of smell, nasal airflow, and polyp size can persist for up to 12 weeks when followed by intranasal maintenance therapy 2, 1
• Alternative regimens include methylprednisolone 32 mg/day for days 1-5,16 mg/day for days 6-10, and 8 mg/day for days 11-20 1

Critical Pitfalls to Avoid

• Never use corticosteroids as monotherapy for bacterial sinusitis—always combine with appropriate antibiotics (amoxicillin or amoxicillin-clavulanate as first-line) 2, 3
• Limit oral corticosteroid courses to 1-2 per year to minimize systemic adverse effects including adrenal suppression 2
• For patients with diabetes, use the lower dose of 25 mg daily for 2 weeks rather than higher doses to minimize glycemic fluctuations 2
• Do not extend treatment beyond 5-7 days for bronchitis or 7-14 days for sinusitis as the risk of adverse events increases with longer duration 1, 2
• The benefit of oral corticosteroids for acute sinusitis is modest and not sustained, so set appropriate patient expectations 2

Special Considerations

• Risk of significant adverse events is low with short courses (2 weeks or less) but increases with longer duration 2
• Risk of adrenal suppression is minimal with a 2-week course unless the patient has had previous recent corticosteroid therapy 2
• For severe postinfectious cough with paroxysms, consider inhaled ipratropium first before escalating to oral corticosteroids 1