What oral corticosteroid dose is recommended for an otherwise healthy adult with a non‑life‑threatening sore throat?

Oral Corticosteroid Dosing for Sore Throat in Adults

For an otherwise healthy adult with severe sore throat (Centor score 3-4), administer a single oral dose of dexamethasone 10 mg alongside antibiotic therapy; for less severe presentations, corticosteroids are not recommended. 1

Clinical Decision Algorithm

Step 1: Assess Severity Using Centor Criteria

• Calculate the Centor score based on: fever, tonsillar exudates, tender anterior cervical lymphadenopathy, and absence of cough 1, 2
• Centor 3-4 (severe): Consider corticosteroids as adjunctive therapy 1
• Centor 0-2 (mild-moderate): Do not use corticosteroids; the effect is considerably smaller in typical primary care populations where most patients lack severe presentations 1, 2

Step 2: Dosing Specifications for Severe Cases

• Dexamethasone 10 mg orally as a single dose is the recommended regimen 1
• This dose is based on corticosteroid equivalency principles (dexamethasone is 25 times more potent than hydrocortisone), providing adequate anti-inflammatory effect without weight-based calculations in adults 1
• Always administer concurrently with appropriate antibiotic therapy (typically penicillin or amoxicillin) 1

Step 3: Screen for Contraindications

Exclude patients with: 1

• Diabetes mellitus or glucose dysregulation
• Current exogenous steroid use
• Endocrine disorders

Expected Clinical Benefits

The addition of a single 10 mg oral dose of dexamethasone provides modest but measurable benefits: 1, 3

• Shortens duration of throat pain by approximately 5 hours (11.6 hours in some analyses)
• Increases likelihood of complete pain resolution at 24 hours by 2.4 times (RR 2.4,95% CI 1.29-4.47) 3
• Reduces pain by an additional 10-14% on visual analogue scales at 24 hours 4, 3
• Number needed to treat: fewer than 5 patients to prevent one person continuing to experience pain at 24 hours 4

Important Caveats and Limitations

Route-Dependent Efficacy

• The analgesic effect appears less pronounced when steroids are given orally compared to intramuscular or intravenous routes 1

Modest Absolute Benefit

• While statistically significant, the actual reduction in pain duration is only approximately 5 hours, which may not be clinically meaningful to all patients 1, 2
• Discuss this modest benefit against possible side effects with patients before prescribing 1

Evidence Gaps

• Studies were not sufficiently powered to detect adverse effects of short courses of oral corticosteroids 1
• Short-term steroid use may have adverse effects not adequately captured in existing trials 1

First-Line Symptomatic Management (All Patients)

Regardless of steroid use decision: 1, 2

• Recommend ibuprofen or paracetamol (acetaminophen) as first-line analgesics for pain and fever control
• Avoid aspirin in children due to Reye syndrome risk 1
• Avoid zinc gluconate (not recommended for sore throat) 1

Antibiotic Co-Therapy Requirements

When prescribing dexamethasone for severe sore throat: 1

• Concurrent administration of an appropriate antibiotic is mandatory
• Standard regimen: 10-day course of penicillin or amoxicillin to eradicate the pathogen and prevent complications such as rheumatic fever
• All trials demonstrating corticosteroid benefit included antibiotic co-administration 4, 3

What NOT to Do

• Do not use corticosteroids routinely for all cases of sore throat 1, 2
• Do not prescribe steroids for hoarseness or dysphonia without proper evaluation (preponderance of harm over benefit) 1
• Do not extrapolate perioperative tonsillectomy dosing (0.5 mg/kg IV) to medical management of acute pharyngitis 1
• The Infectious Diseases Society of America explicitly states that adjunctive corticosteroid therapy is not recommended for routine group A streptococcal pharyngitis due to minimal clinical benefit and self-limited disease 2