What is the recommended dose of prednisone (corticosteroid) for a child weighing 37kg?

Prednisone Dosing for a 37kg Child

For a child weighing 37kg, the recommended prednisone dose is 60 mg/m² per day (maximum 60 mg) or approximately 2 mg/kg per day, which would be 74 mg/day using the body surface area calculation or 74 mg using the equation [2 × Weight + 8]. 1, 2

Dosing Calculations

Body Surface Area (BSA) Method

• The preferred method for calculating pediatric prednisone dosing is using BSA at 60 mg/m² per day 1
• This is more accurate than weight-based dosing, especially for children under 30kg 3

Weight-Based Method

• The alternative weight-based dosing is 2 mg/kg/day 1
• For a 37kg child: 37kg × 2 mg/kg = 74 mg/day

Simplified Equation Method

• A validated equation to estimate the BSA-based dose of 60 mg/m² using only weight is: [2 × Weight + 8] 2
• For a 37kg child: [2 × 37 + 8] = 82 mg/day

Clinical Considerations

Dosing Recommendations Based on Indication

1. For Nephrotic Syndrome (Initial Episode):

   • 60 mg/m² per day (maximum 60 mg) as a single daily dose for 6 weeks 1
   • Followed by 40 mg/m² on alternate days for 6 weeks 1
   • Then taper by 10 mg/m² per week 1

2. For Nephrotic Syndrome Relapse:

   • 60 mg/m² per day (maximum 60 mg) until remission (urine dipstick trace/negative for at least 3 consecutive days) 1
   • Then 40 mg/m² on alternate days for 1 week 1
   • Then taper by 10 mg/m² per week to complete a total of 4 weeks 1

3. For Asthma Exacerbations:

   • 1-2 mg/kg daily for 5 days 4

Important Dosing Considerations

• Weight-based dosing (2 mg/kg/day) can lead to underdosing compared to BSA-based dosing (60 mg/m²/day), especially in children weighing <30kg 3
• Underdosing may not affect initial response but increases the likelihood of a frequently relapsing course 5
• Single daily morning dosing is as effective as divided doses for nephrotic syndrome 6
• Maximum daily dose is generally capped at 60 mg for children 1

Administration Guidelines

• Administer as a single daily dose in the morning 1, 6
• Round doses to account for available tablet strengths (typically 5mg tablets) 1
• For long-term therapy, use the lowest effective dose to maintain remission without major adverse effects 1
• Never stop prednisone abruptly due to risk of adrenal insufficiency

Monitoring

• Monitor for steroid-related adverse effects including:
  • Blood pressure at each clinic visit
  • Glucose levels (urine dipstick)
  • Signs of infection
  • Mood changes and sleep disturbances
  • Growth parameters

By using the BSA-based calculation or the validated equation [2 × Weight + 8], you can ensure optimal dosing for this 37kg child while minimizing the risk of underdosing that could lead to treatment failure or frequent relapses.