Corticosteroid Tapering for Severe Inflammatory Parotitis

Initial Treatment and Tapering

• The American College of Physicians recommends starting with prednisone 0.5-1.0 mg/kg daily (maximum 80 mg daily) for severe inflammatory parotitis, tapering over 1-2 weeks 1, 2

Tapering Schedule

• For doses >30 mg/day, the European Society of Clinical Microbiology and Infectious Diseases suggests reducing by 5 mg every week until reaching 10 mg/day, then slowing the taper to 2.5 mg/week until reaching 5 mg/day 3
• For doses <10 mg/day, the guideline recommends tapering by 1 mg every 4 weeks 3

Critical Considerations

• The European Heart Journal warns against using a dose too low to be effective or tapering too rapidly, and recommends returning to the pre-relapse dose and maintaining for 2-3 weeks before recommencing taper if symptoms recur during tapering 4, 5
• The guideline also notes that hypothalamic-pituitary-adrenal axis suppression should be anticipated in any patient receiving >7.5 mg daily for >3 weeks, and tapering is necessary to prevent adrenal insufficiency 3