• Home
    • Clinical Curriculum
    • Didactic Curriculum
    • Sub-Specialties
    • Diversity and Inclusion
    • Residency Awards
    • Wellness
    • Cook County ED
    • Benefits
    • Interview Day Logistics
    • About Chicago
    • FAQ
    • Contact Information
    • Medical Student Elective
    • Rotating Student Resources
    • Diversity Externship Scholarship
    • Ultrasound
    • Simulation
    • Toxicology
    • Residents
    • Fellows
    • Faculty
    • Program Directors
    • Where We're From
    • Where Are We Going?
    • Alumni
  • Blog
Menu

Cook County Emergency Medicine Residency

  • Home
  • Residency
    • Clinical Curriculum
    • Didactic Curriculum
    • Sub-Specialties
    • Diversity and Inclusion
    • Residency Awards
    • Wellness
  • Recruitment
    • Cook County ED
    • Benefits
    • Interview Day Logistics
    • About Chicago
    • FAQ
    • Contact Information
  • Students
    • Medical Student Elective
    • Rotating Student Resources
    • Diversity Externship Scholarship
  • Fellowships
    • Ultrasound
    • Simulation
    • Toxicology
  • People
    • Residents
    • Fellows
    • Faculty
    • Program Directors
    • Where We're From
    • Where Are We Going?
    • Alumni
  • Blog

the County Consult

A Cook County Hospital Emergency Medicine Blog for up-to-date medicine and more.

Source: Image by benzoix on Freepik

PharmD Pearls - The Quiet Guardians in PTA

April 6, 2024

Bedside Clinical Question

· Why is Dexamethasone the preferred steroid in PTA instead of Hydrocortisone or Prednisone?

Background

· Peritonsillar abscesses (PTAs) are a complication of acute tonsillitis and the most common deep infection of the head and neck. The treatment of PTAs requires the selection of an appropriate antibiotic, an effective procedure to remove the pus collection, and resolution of inflammation. Dexamethasone is the corticosteroid of choice for reducing edema and inflammation in this disease state.

· Corticosteroids work by activating specific receptors that offer differing results. Glucocorticoid activation lowers inflammatory molecules, while mineralocorticoid activation regulates electrolytes and blood pressure.

Answer

· Steroids are categorized into three types: short-acting (Hydrocortisone), intermediate (Prednisone), and long-acting (Dexamethasone). Their potency increases from the shortest to the longest acting.

· Dexamethasone is 25 times more potent in glucocorticoid activity than Hydrocortisone and 6 times more potent than Prednisone, offering a significantly greater anti-inflammatory effect. For instance, a 0.75 mg dose of Dexamethasone is equivalent to 4 mg of Prednisone and 20 mg of Hydrocortisone. Using the steroid of higher potency provides the greatest protection of the airway by reducing inflammation.

· Individuals suffering from PTA require airway protection. Using a highly potent steroid, such as Dexamethasone, offers superior anti-inflammatory control aiding in the protection of the airway.

Conclusion

· In summary, Dexamethasone is the preferred corticosteroid for treating PTAs due to its potent anti-inflammatory properties. By effectively reducing edema and inflammation through glucocorticoid receptor activation, Dexamethasone ensures superior airway protection for PTA patients.

Written by: Aonyea Spinks-Boykins, P4 Pharmacy Student, MWU Doctor Pharmacy Candidate

Reviewed by: Joanne C Routsolias, PharmD, RN, BCPS

Clinical PharmD Specialist - Emergency Medicine/Toxicology

References

  1. Lee YJ, Jeong YM, Lee HS, Hwang SH. The Efficacy of Corticosteroids in the Treatment of Peritonsillar Abscess: A Meta-Analysis. Clin Exp Otorhinolaryngol. 2016;9(2):89-97. doi:10.21053/ceo.2014.01851

  2. Johnson RF, Stewart MG, Wright CC. An evidence-based review of the treatment of peritonsillar abscess. Otolaryngol Head Neck Surg. 2003;128(3):332-343. doi:10.1067/mhn.2003.93

  3. Chau JK, Seikaly HR, Harris JR, Villa-Roel C, Brick C, Rowe BH. Corticosteroids in peritonsillar abscess treatment: a blinded placebo-controlled clinical trial. Laryngoscope. 2014;124(1):97-103. doi:10.1002/lary.24283

In Pharmacology Tags PharmD Pearl, Pharmocology
← Ms4 Infographic - Beta Blocker ToxicityThe Heart of the Matter - An Inferior Myocardial Infarction →
  • Abdomen/GI
  • Cardiology
  • Critical Care
  • HEENT
  • Infectious Disease
  • Neurology
  • OB/GYN
  • Orthopedics/MSK
  • Pediatrics
  • Pharmacology
  • Psychiatry
  • Pulmonary
  • Renal
  • Sim Corner
  • Social EM
  • Toxicology
  • Trauma
  • Ultrasound
Tweets by @CookCountyEM

Contact Information

© 2020 Cook County Emergency Medicine