Steroids, Antivirals and Antibiotics

Where facial paralysis is thought to be caused by an infection, various medical treatments may be prescribed.

Caution: This information is intended just to explain how and when these treatments may be used. You should always seek advice from your GP before taking any medication.

Steroids

Relevant to: Bell’s palsy, Ramsay Hunt syndrome.

A steroid called Prednisolone is commonly used to treat patients with Bell’s palsy. This should be commenced within 72 hours of the symptoms (1) appearing and works by helping to reduce inflammation. There is limited evidence at present to suggest that there is any benefit in taking steroids beyond the 72-hour time window and certainly not beyond 7 days The sooner the steroids are started the better. People with Bell’s palsy are usually advised to take prednisolone tablets twice a day for 10 days.

It is important to remember that even treatment with steroids within 72 hours of onset of symptoms will not guarantee a full recovery in all cases. However, this treatment will give you the best possible chance of making a full recovery and should be taken if prescribed by your GP.

Where a diagnosis of Ramsay Hunt syndrome is suspected steroids can be prescribed in addition to antivirals( see below). BMJ Best Practice states ‘prompt combination treatment (within 72 hours) with high-dose oral corticosteroids and antivirals is recommended in all patients.’(3) While the effectiveness of the use of steroids for treatment of Ramsay Hunt syndrome is not proven it is unlikely to do harm and can potentially help with pain and recovery.

Frequently asked:

Question: Are steroids safe for children to take?

Caution: You should always seek advice from the health professional in charge of your child’s care before giving them any medication as they will know your child’s full medical history.

Answer: Steroids are safe in children in short courses.  There is less evidence for the effectiveness of steroids in the outcome of Bell’s palsy in children. This is due to a lack of trials combined with the generally good outcome in children. The decision to prescribe steroids will therefore depend on the clinical picture and your clinician’s assessment of risk vs benefit.

Question: Are steroids safe to take when I have another health condition?

Answer: You should always tell your health care provider if you have another health condition when being prescribed steroids. Examples might be diabetes,  high blood pressure, stomach ulcers and mood or psychiatric disorders. Your clinician  will then discuss the pros and cons of steroid treatment with you. You may need additional monitoring while taking steroids e.g. glucose monitoring in diabetes. Obstetricians recommend that steroids can be used in pregnancy

Question: What time of day should I take steroids?

Answer: It is best to take steroids with breakfast or lunch (not on an empty stomach) and not later in the day as the medication can cause insomnia.

Question: What are the commonest side-effects with short-term steroids?

Answer: Steroids are only prescribed for a short period in facial palsy, usually about 10-14 days. Consequently, the commonest side-effects are increased appetite, mood changes and difficulty sleeping. The chronic, more serious side effects associated with steroids are unlikely given the short duration although it is extremely important to monitor blood glucose in diabetics

Antivirals

Relevant to: Ramsay Hunt syndrome. Bell’s palsy, if uncertainty as whether could be Ramsay Hunt syndrome without a rash.

Where Ramsay Hunt syndrome is suspected, antiviral medications such as Valacyclovir (also known as Valtrex), Aciclovir (previously known as Acyclovir, also known as Zovirax) or Famciclovir (also known as Famvir) are usually prescribed for 7 to 10 days. This medication may reduce the severity and duration of Ramsay Hunt syndrome if given promptly after onset of symptoms.

Antivirals may be recommended in cases initially diagnosed as Bell’s palsy where there is uncertainty as to whether the facial palsy may in fact be Ramsay Hunt syndrome with no rash (Zoster Sine Herpete) or complex symptoms such as increased pain or deafness suggest there is a possibility of an evolving Ramsay Hunt syndrome. Severe pain with or without additional symptoms such as balance issues, dizziness or hearing problems are more common with Ramsay Hunt syndrome.

Antiviral drugs have few significant side-effects so it is reasonable to consider prescribing them in addition to steroids, where uncertainty exists, as this represents a low risk strategy.

Antibiotics

Relevant to: Lyme disease.

When a patient is diagnosed with Lyme disease, they are treated with antibiotics because this is a bacterial infection.

Patients should discuss the side effects of medications with their GP and ensure they read the medicine information leaflet.

 

Sources:

1: https://cks.nice.org.uk/topics/bells-palsy/management/management/

2: https://bestpractice.bmj.com/topics/en-

3: Ramsay Hunt syndrome – Symptoms, diagnosis and treatment | BMJ Best Practice

Last reviewed: 11-01-2024    ||    Next review due: 11-01-2026