From the Guidelines
Prednisone can be used for severe sinus drainage associated with significant inflammation, but it's not a first-line treatment. For most cases of sinus drainage, start with over-the-counter options like saline nasal sprays, antihistamines, or decongestants. If these don't provide relief, intranasal corticosteroid sprays (like fluticasone or mometasone) are typically tried before oral steroids. According to the european position paper on rhinosinusitis and nasal polyps 2020 1, a short course of systemic corticosteroids can be a useful addition to nasal corticosteroid treatment in patients with partially or uncontrolled disease.
Key Points to Consider
- Oral prednisone is generally reserved for severe cases, typically prescribed as a short course of 5-7 days, often starting at 40-60mg daily and tapering down, as seen in studies such as Vaidyanathan 2011 and Van Zele 2010, which demonstrated significant improvements in symptoms and nasal polyp scores with short-term oral corticosteroid therapy 1.
- The dosage should be determined by a healthcare provider based on the severity of symptoms and patient factors, considering the potential side effects of prednisone, including mood changes, increased blood sugar, fluid retention, and immune suppression.
- Always consult with a healthcare provider before taking prednisone, as it requires proper medical evaluation and supervision, especially given the potential for adverse events and the importance of weighing the benefits against the risks, as noted in the study by Hissaria 2006 1.
Treatment Approach
- Start with over-the-counter options and progress to intranasal corticosteroid sprays if necessary, reserving oral prednisone for severe cases or when other treatments have failed, as suggested by the practice parameter update on the diagnosis and management of sinusitis 1.
- Consider the patient's overall health, medical history, and potential interactions with other medications when prescribing prednisone, and monitor for any adverse effects, as recommended by the european position paper on rhinosinusitis and nasal polyps 2020 1.
From the Research
Sinus Drainage and Prednisone
- Prednisone can be used to relieve symptoms of acute sinusitis, including sinus drainage, as an adjunctive therapy to oral antibiotics 2.
- The effectiveness of oral corticosteroids, such as prednisone, in relieving symptoms of acute sinusitis has been shown in several studies, with a significant reduction in symptoms at Days 3 to 7 and Days 4 to 10 or 12 2.
- However, the use of oral corticosteroids for chronic rhinosinusitis without polyposis is still a topic of debate, with some studies suggesting that it may not be beneficial 3.
Dosage and Administration
- The dosage of prednisone for sinus drainage can vary, with studies using doses ranging from 24 mg to 80 mg daily 2.
- The duration of treatment can also vary, with some studies using a 12-day postoperative taper of oral prednisone 3.
- The prescribing habits of oral corticosteroids for rhinosinusitis can be heterogeneous, with significant discrepancies between survey results and evidence-based recommendations 4.
Side Effects and Risks
- The reported side effects of oral corticosteroids, such as prednisone, are limited and mild 2.
- However, the use of oral corticosteroids can also have risks, such as worsening psychological dysfunction, as shown in one study 3.
- The risks of oral corticosteroids may outweigh the benefits in some cases, and their use should be carefully considered 3.