From the Guidelines
Prednisolone is not recommended for the treatment of bronchitis in a 9-month-old infant, as the condition is typically viral in origin and supportive care is the mainstay of treatment. The American Academy of Pediatrics (AAP) clinical practice guideline on the diagnosis, management, and prevention of bronchiolitis, published in Pediatrics in 2014 1, emphasizes the importance of supportive care, including ensuring adequate hydration, using saline nasal drops to clear congestion, and using a cool-mist humidifier to ease breathing. Acetaminophen or ibuprofen may be given for fever or discomfort at age-appropriate doses.
Key points to consider in the management of bronchitis in infants include:
- The condition is usually self-limiting and does not require antibiotic treatment unless there is a confirmed bacterial infection
- Corticosteroids like prednisolone are typically reserved for more severe respiratory conditions such as croup or asthma exacerbations
- The risks of side effects from steroids in young infants, including potential impacts on growth and immune function, outweigh the benefits for a condition that is usually self-limiting
- If the infant has wheezing or difficulty breathing, they should be evaluated by a healthcare provider immediately, as this could indicate a more serious condition requiring different management
The AAP guideline also recommends against the routine use of bronchodilators, such as albuterol, in infants with bronchiolitis, as they have not been shown to be effective in improving outcomes 1. Additionally, the guideline recommends against routine radiographic or laboratory studies, unless there are signs of a more serious condition, such as an airway complication or severe respiratory distress 1.
Overall, the management of bronchitis in a 9-month-old infant should focus on supportive care and monitoring for signs of more serious conditions, rather than the use of prednisolone or other medications.
From the FDA Drug Label
The National Heart, Lung, and Blood Institute (NHLBI) recommended dosing for systemic prednisone, prednisolone or methylprednisolone in children whose asthma is uncontrolled by inhaled corticosteroids and long-acting bronchodilators is 1–2 mg/kg/day in single or divided doses In pediatric patients, the initial dose of prednisolone sodium phosphate oral solution may vary depending on the specific disease entity being treated. The range of initial doses is 0. 14 to 2 mg/kg/day in three or four divided doses (4 to 60 mg/m2bsa/day)
The recommended treatment for bronchitis in a 9-month-old regarding the use of prednisolone is not directly stated in the label. However, for asthma, which may be related to bronchitis, the recommended dose is 1-2 mg/kg/day.
- For a 9-month-old patient, the dose would depend on the patient's weight.
- The label does not provide specific guidance for bronchitis. 2
From the Research
Treatment for Bronchitis in a 9-Month-Old
The recommended treatment for bronchitis in a 9-month-old is mainly supportive, focusing on maintaining oxygen saturation, hydration, and nutrition.
- The use of prednisolone, a corticosteroid, is not recommended for the treatment of bronchiolitis in infants, as stated in studies 3, 4, 5, 6.
- Supportive measures such as minimal handling, securing adequate oxygenation, and hydration are generally recommended 3, 4, 6.
- Other therapies like bronchodilators, epinephrine, nebulized hypertonic saline, antibiotics, and chest physiotherapy are not recommended for the treatment of bronchiolitis 3, 4, 6.
- Inhaled corticosteroids may be considered for children with frequently recurring and/or severe episodes of wheezy bronchitis, but not for acute bronchiolitis 4.
Specific Considerations for Prednisolone
- There is no convincing evidence that prednisolone or any other form of corticosteroid therapy will reliably provide beneficial effects in infants with bronchiolitis 5, 6.
- Studies have failed to show any benefit of significant extent from the use of corticosteroids in the treatment of bronchiolitis 5, 6.