What is the recommended dose of prednisone (corticosteroid) for a 15-year-old patient weighing 55 kilograms?

Prednisone Dosing for a 15-Year-Old Patient Weighing 55 kg

For a 15-year-old patient weighing 55 kg, the appropriate prednisone dose is 1-2 mg/kg daily (up to 60 mg/day), which equals 55-60 mg once daily for most conditions requiring high-dose therapy. 1

Age-Based Dosing Considerations

At 15 years of age, this patient should receive adult dosing according to multiple guidelines:

• The American Thoracic Society/CDC/IDSA guidelines specifically state that "adult dosing begins at age 15 years" 2
• For autoimmune hepatitis, the American Association for the Study of Liver Diseases recommends prednisone at 1-2 mg/kg daily (up to 60 mg/day) for pediatric patients 2, 1

Condition-Specific Dosing

The appropriate dose depends on the specific condition being treated:

Autoimmune Conditions

• Autoimmune hepatitis: 1-2 mg/kg daily (55-60 mg/day) 2
• Bullous pemphigoid:
  • Severe: 0.75-1 mg/kg (41-55 mg/day)
  • Moderate: 0.5 mg/kg (27.5 mg/day)
  • Mild: 0.3 mg/kg (16.5 mg/day) 2

Neurological Conditions

• Duchenne muscular dystrophy: 0.75 mg/kg/day (41.25 mg/day) is more effective than 0.3 mg/kg/day, with the minimum effective dose being 0.3 mg/kg/day (16.5 mg/day) 2, 3

Inflammatory Conditions

• Alcoholic hepatitis: 40 mg/day for 28 days, then tapered 2

Dosing Algorithm

1. Determine disease severity:

   • Severe disease: 1-2 mg/kg/day (55-60 mg/day)
   • Moderate disease: 0.5-0.75 mg/kg/day (27.5-41.25 mg/day)
   • Mild disease: 0.3-0.5 mg/kg/day (16.5-27.5 mg/day)

2. Consider dosing cap:

   • Maximum dose generally capped at 60 mg/day for pediatric patients 1

3. Consider dosing schedule:

   • Daily dosing is generally more effective than alternate-day dosing 4
   • For some conditions like Duchenne muscular dystrophy, alternative regimens may include high-dose weekend therapy 2

Tapering Recommendations

When discontinuing therapy:

• Reduce daily dose by 5 mg weekly until reaching 10 mg/day
• Then reduce by 2.5 mg weekly until discontinuation 2, 1

Important Monitoring Considerations

For this 15-year-old patient on prednisone:

• Short-term therapy: Monitor for immediate side effects including increased appetite, weight gain, mood changes, and insomnia
• Long-term therapy: Monitor for:
  • Growth (although less critical at age 15)
  • Bone mineral density
  • Blood pressure
  • Blood glucose
  • Weight gain
  • Cushingoid features 1

Common Pitfalls to Avoid

1. Underdosing small children: Weight-based dosing may lead to relative underdosing in smaller children compared to BSA-based dosing 5, but this is less of a concern for a 15-year-old patient of average weight

2. Abrupt discontinuation: Never stop prednisone abruptly after prolonged use due to risk of adrenal crisis 1

3. Alternate-day dosing: While sometimes used to reduce side effects, studies show that alternate-day dosing is less effective at maintaining improvement compared to daily dosing 4

4. Failure to provide bone protection: For long-term therapy, consider calcium and vitamin D supplementation to prevent osteoporosis 1