What is the recommended dose of prednisone (corticosteroid) for a severe sore throat?

Prednisone Dosing for Severe Sore Throat

For adults with severe sore throat, a single oral dose of 10 mg dexamethasone (equivalent to approximately 60 mg prednisone) provides significant symptom relief, with complete resolution twice as likely at 24 hours and 1.5 times more likely at 48 hours compared to placebo. 1, 2

Evidence-Based Dosing Recommendations

Single-Dose Regimen (Preferred)

• 10 mg oral dexamethasone as a single dose is the most studied and effective approach 1
• Alternative: 60 mg oral prednisone as a single dose for 1-2 days has also demonstrated efficacy 3
• This provides pain relief approximately 4.8 hours earlier than placebo and complete resolution 11.1 hours earlier 2

When to Use Corticosteroids

Corticosteroids are most beneficial for:

• Adults with severe sore throat (high Centor scores of 3-4) 4
• Patients experiencing moderately bad to severe symptoms that significantly impact quality of life 1, 2
• Can be used with or without antibiotics—the 2017 JAMA trial specifically demonstrated benefit in patients not receiving immediate antibiotics 1

Clinical Outcomes You Can Expect

• 22.6% complete symptom resolution at 24 hours (vs 17.7% with placebo) 1
• 35.4% complete symptom resolution at 48 hours (vs 27.1% with placebo), representing an 8.7% absolute risk difference 1
• Pain reduction of 1.3 points on a 0-10 visual analog scale at 24 hours 2
• No increase in adverse events across multiple trials 2

Important Clinical Caveats

When NOT to Use Corticosteroids

• Do not use routinely for all sore throats—reserve for severe presentations 4
• Not recommended for children—the systematic review found no significant benefit in pediatric populations 4
• Avoid in patients with suspected bacterial sinusitis or early Bordetella pertussis infection where antibiotics are the primary treatment 4

Safety Considerations

• Single low-dose courses (1-2 days) do not require tapering 5
• No increased risk of symptom recurrence or bacterial complications was observed in trials 3, 2
• Nine of 10 trials specifically assessed adverse events and found no increase in serious complications 2
• Short courses have minimal risk of adrenal suppression (risk primarily exists with doses >7.5 mg/day for >3 weeks) 6

Practical Algorithm

1. Assess severity: Use Centor criteria or clinical judgment to identify severe presentations
2. Rule out immediate antibiotic indications: Peritonsillar abscess, severe bacterial infection
3. Prescribe single dose: 10 mg dexamethasone OR 60 mg prednisone orally
4. Provide delayed antibiotic prescription if appropriate (corticosteroids work with or without antibiotics) 1
5. Counsel patient: Expect pain relief within 5 hours; complete resolution may take 24-48 hours 2

Common Pitfall to Avoid

The most significant error is using multi-day tapering regimens when evidence supports single-dose therapy. The 2017 BMJ meta-analysis specifically identified single low-dose corticosteroids as the effective intervention 2. Longer courses increase cumulative steroid exposure without proven additional benefit for acute sore throat 2.