What is the recommended dose of prednisolone (steroid) for an adult patient with a severe sore throat?

Recommended Steroid Dose for Severe Sore Throat in Adults

For adults with severe sore throat (Centor score 3-4), administer a single oral dose of dexamethasone 10 mg in conjunction with antibiotic therapy. 1

Dosing Recommendations by Severity

Severe Presentations (Centor Score 3-4)

• Single oral dose of dexamethasone 10 mg is the preferred regimen for adults with severe sore throat 1
• This dose is based on corticosteroid equivalency principles, where dexamethasone is 25 times more potent than hydrocortisone 1
• Should be administered alongside appropriate antibiotic therapy 2, 1
• Alternative option: Prednisone 60 mg orally for 1-2 days has also demonstrated efficacy 3

Mild to Moderate Presentations (Centor Score 0-2)

• Corticosteroids are not recommended for routine use in less severe presentations 2
• Focus on analgesics (ibuprofen or paracetamol) for symptom relief 2, 1

Clinical Evidence Supporting This Approach

The recommendation for dexamethasone 10 mg is supported by high-quality evidence:

• At 48 hours, corticosteroids increased complete symptom resolution by 1.5 times (RR 1.50,95% CI 1.27-1.76) 4
• A large randomized trial of 576 adults showed that dexamethasone 10 mg achieved complete resolution in 35.4% vs 27.1% with placebo at 48 hours (risk difference 8.7%, P=0.03) 5
• Corticosteroids reduced mean time to onset of pain relief by more than 6 hours 4, 6
• The number needed to treat is 5 patients to prevent one person continuing to experience pain at 24 hours 4

Important Contraindications

Exclude patients with: 1

• Diabetes mellitus or glucose dysregulation
• Current use of exogenous steroids
• Endocrine disorders

Clinical Decision Algorithm

1. Assess severity using Centor criteria (fever, tonsillar exudates, tender anterior cervical lymphadenopathy, absence of cough) 2, 1

2. If Centor score 3-4:

   • Prescribe dexamethasone 10 mg single oral dose 1
   • Add appropriate antibiotic therapy 2, 1
   • Prescribe ibuprofen or paracetamol for additional symptom relief 2, 1

3. If Centor score 0-2:

   • Do not prescribe corticosteroids 2
   • Offer analgesics only 2

Key Caveats

• Benefits are modest and must be weighed against potential side effects, though short-term adverse effects were not adequately captured in existing studies 4
• The effect appears smaller in typical primary care populations where most patients do not have severe sore throat 1
• No significant benefit demonstrated in children with sore throat 1
• Corticosteroids should not be used routinely for all cases of sore throat 2, 1
• Discuss the likely modest benefits with patients before prescribing 2