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

Prednisone Dosing for Severe Sore Throat

For adults with severe sore throat (Centor score 3-4), use a single oral dose of 10 mg dexamethasone or 60 mg prednisone for 1-2 days without requiring a taper. 1, 2, 3

Patient Selection Criteria

• Corticosteroids are recommended specifically for adults with severe sore throat, typically defined by high Centor scores of 3-4 (fever, tonsillar exudates, tender anterior cervical lymphadenopathy, absence of cough). 1
• Do not use corticosteroids in children with sore throat—systematic reviews found no significant benefit in pediatric populations. 1
• Avoid corticosteroids in patients with suspected bacterial sinusitis or early Bordetella pertussis infection, where antibiotics remain the primary treatment. 1

Specific Dosing Regimens

Two evidence-based options exist:

• Dexamethasone 10 mg as a single oral dose (most studied in recent high-quality trials). 3
• Prednisone 60 mg orally for 1-2 days (validated in earlier primary care studies). 2

The dexamethasone regimen is preferred due to longer half-life and single-dose convenience, though prednisone 60 mg daily for 1-2 days is equally acceptable. 2, 3

Expected Clinical Outcomes

• At 24 hours, corticosteroids show modest benefit with approximately 5% absolute increase in complete symptom resolution (not statistically significant in the largest trial). 3
• At 48 hours, corticosteroids provide an 8.7% absolute increase in complete symptom resolution (35.4% vs 27.1%), with a number needed to treat of approximately 12. 3
• Pain relief occurs more rapidly in the first 24-48 hours compared to placebo, even without antibiotics. 2, 3
• This benefit persists whether or not delayed antibiotics are prescribed, making corticosteroids useful as an alternative to immediate antibiotic therapy. 3

Safety Profile and Tapering

• Single low-dose courses of 1-2 days do not require tapering and carry minimal risk of adrenal suppression. 1
• Adrenal suppression risk primarily exists with doses >7.5 mg/day for >3 weeks, which does not apply to this short-course regimen. 1
• No adverse effects were reported in primary care trials using these short courses. 2

Clinical Algorithm

For adults presenting with severe sore throat:

1. Calculate Centor score (if 3-4, proceed with corticosteroid consideration). 1
2. Rule out bacterial sinusitis or pertussis as primary diagnosis. 1
3. Offer either dexamethasone 10 mg single dose OR prednisone 60 mg daily for 1-2 days. 2, 3
4. Consider delayed antibiotic prescription or no antibiotics based on clinical judgment—corticosteroids work in both scenarios. 3
5. No taper required for these short courses. 1

Important Caveats

• The benefit is modest—approximately 1 in 12 patients will achieve complete symptom resolution at 48 hours who would not have with placebo alone. 3
• Corticosteroids provide symptomatic relief but do not treat underlying bacterial infection if present. 4
• This represents an evidence-based alternative to reflexive antibiotic prescribing for acute sore throat, addressing the significant burden of inappropriate antibiotic use in primary care. 4