A 28-year-old woman presents with acute complete left lower motor neuron facial palsy of 36 hours duration. Otoscopy, neurology, and vestibular examination are normal. What is the correct drug management?
- A Oral prednisolone alone started after 7 days if no spontaneous recovery occurs
- B Oral prednisolone started immediately, with an antiviral added because the palsy is complete ✓
- C Intravenous methylprednisolone pulse therapy for 3 days
- D Acyclovir monotherapy for 10 days
Correct answer: B. Oral prednisolone started immediately, with an antiviral added because the palsy is complete
Explanation
Bell's palsy is treated with oral prednisolone (about 1 mg/kg/day, typically 60 mg daily) begun within 72 hours of onset, usually for 5 days followed by tapering. An antiviral such as valacyclovir or acyclovir is added when the palsy is complete or severe, though antivirals alone add nothing over steroids. Delaying steroids beyond 72 hours reduces their benefit, and intravenous pulses are reserved for special situations, not routine Bell's palsy.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.