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
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
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
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