What is the recommended prednisone (corticosteroid) dosage for a 17-year-old patient with bronchitis, wheezing, and cough, and an oxygen saturation (SpO2) of 96%?

Prednisone Dosage for Bronchitis in a 17-Year-Old

For a 17-year-old patient (61 kg) with bronchitis presenting with wheezing and cough with SpO2 of 96%, the recommended prednisone dosage is 30-40 mg daily for a short course of 5-10 days without tapering. 1

Assessment and Classification

Before initiating treatment, it's important to determine the specific type of bronchitis:

• Postinfectious cough: If symptoms have persisted for 3-8 weeks following a respiratory infection
• Acute bronchitis with wheezing: If symptoms are more recent with prominent wheezing
• Rule out asthma: Wheezing may indicate underlying asthma or asthma-like reactivity

The patient's SpO2 of 96% indicates adequate oxygenation, which is reassuring but doesn't eliminate the need for treatment if symptoms are significant.

Treatment Recommendations

Corticosteroid Therapy

1. Prednisone dosing:

   • Adult dosage: 30-40 mg daily for 5-10 days 1
   • Pediatric/adolescent dosage: 1-2 mg/kg/day (maximum 60 mg/day) for 3-10 days 1
   • For this 61 kg patient: 40 mg daily (approximately 0.65 mg/kg) is appropriate

2. Duration of therapy:

   • 5-10 days is typically sufficient 1
   • No need to taper for courses less than 10 days 1

Additional Therapies to Consider

• Inhaled bronchodilators: Consider a trial of inhaled ipratropium bromide as it may attenuate cough 1
• Inhaled corticosteroids: May be considered if cough persists despite ipratropium 1
• Antibiotics: Not indicated unless there is evidence of bacterial infection 1

When to Use Prednisone

Prednisone should be reserved for:

• Severe paroxysms of postinfectious cough 1
• When other common causes of cough have been ruled out (upper airway cough syndrome, asthma, GERD) 1
• When symptoms significantly affect quality of life 1

Monitoring and Follow-up

• Assess response to therapy within 3-5 days
• If no improvement occurs, reconsider the diagnosis
• Monitor for side effects of short-term corticosteroid use (insomnia, increased appetite, mood changes)

Important Caveats

• Morning dosing: Administer prednisone in the morning (before 9 AM) to minimize adrenal suppression 2
• Take with food: Administer with food to reduce gastric irritation 2
• Short-term use only: Prolonged use increases risk of adverse effects 3
• No antibiotics: Unless there is clear evidence of bacterial infection 1

Special Considerations for Adolescents

• The 17-year-old patient is approaching adult dosing guidelines but still falls under pediatric recommendations
• The maximum dose of 60 mg/day should not be exceeded 1
• Consider the patient's weight (61 kg) when determining the exact dose

Prednisone can effectively reduce airway inflammation and improve symptoms in bronchitis with wheezing, but should be used judiciously and for the shortest duration necessary to achieve symptom control.