Corticosteroid Treatment for Sinusitis

Acute Sinusitis

For acute post-viral sinusitis, prednisone 30 mg daily for 7 days as an adjunct to antibiotics provides modest short-term symptom relief, though the benefit is small and not sustained beyond 10-14 days 1, 2
Oral corticosteroids combined with antibiotics show a modest benefit with resolution of facial pain in 4-7 days (risk ratio 1.17, 95% CI 1.05-1.30), meaning 11% more patients improve compared to placebo 1
The benefit of oral corticosteroids is not sustained at 10-14 days after treatment initiation 1
Nearly two-thirds of patients improve with placebo alone, making the absolute benefit small 1
No difference in recovery rates at 7-14 days between corticosteroid and placebo groups 1

Prednisone 25 mg daily for 2 weeks followed by intranasal corticosteroids is the recommended regimen for chronic rhinosinusitis 3
Oral corticosteroids combined with intranasal corticosteroids provide greater improvement in symptoms, polyp scores, and quality of life compared to intranasal corticosteroids alone 3
Improvements in sense of smell, nasal airflow, and polyp size can persist for up to 12 weeks when followed by intranasal maintenance therapy 3

For patients with diabetes, use prednisone 25 mg daily for 2 weeks rather than higher doses to minimize glycemic fluctuations 3
Limit oral corticosteroid courses to 1-2 per year to minimize systemic adverse effects 3

Risk of significant adverse events is low with short courses (2 weeks or less) but increases with longer duration 3
Risk of adrenal suppression is minimal with a 2-week course unless patient has had previous corticosteroid therapy 3