What is the recommended dose of prednisolone (corticosteroid) for pediatric patients?

Pediatric Prednisolone Dosing Guidelines

The recommended dose of prednisolone for pediatric patients is 0.5-2 mg/kg/day or 40-60 mg/m²/day (maximum 60 mg/day) with dosing adjusted based on the specific condition being treated. 1

General Dosing Principles

• For most pediatric conditions, prednisolone dosing ranges from 0.14 to 2 mg/kg/day divided into three or four doses (equivalent to 4-60 mg/m²/day) 1
• Maximum daily dose is typically 60 mg, though in some cases up to 80 mg may be considered for specific conditions 2
• For significantly overweight children, dosing should be based on ideal body weight to avoid unnecessary steroid exposure 2

Condition-Specific Dosing

Nephrotic Syndrome

• First episode treatment: 60 mg/m²/day or 2 mg/kg/day (maximum 60 mg/day) as a single daily dose for 4-6 weeks, followed by 40 mg/m²/day or 1.5 mg/kg/day (maximum 40 mg) on alternate days for 2-5 months with tapering 2, 1
• Infrequent relapses: 60 mg/m²/day or 2 mg/kg/day (maximum 60 mg/day) until remission for at least 3 days, then 40 mg/m²/day or 1.5 mg/kg/day on alternate days for at least 4 weeks 2
• Frequent relapses/steroid-dependent: Daily prednisolone until remission for 3 days, followed by alternate-day prednisolone for at least 3 months at the lowest effective dose 2

Asthma Exacerbations

• Acute exacerbations: 1-2 mg/kg/day (maximum 60 mg/day) until peak flow reaches 80% of personal best or symptoms resolve (typically 3-10 days) 1
• Hospitalized patients: 0.5 mg/kg/day has been shown to be as effective as higher doses (1-2 mg/kg/day) for acute exacerbations 3
• Note: Oral prednisolone is as effective as intravenous methylprednisolone for hospitalized children with asthma 4

Autoimmune Hepatitis

• Initial regimen: 1-2 mg/kg/day (maximum 60 mg/day) for two weeks, either alone or with azathioprine 2
• Maintenance: Taper over 6-8 weeks to 0.1-0.2 mg/kg/day or 5 mg/day 2

Administration Considerations

• For most conditions, prednisolone is administered as a single daily dose in the morning to minimize adrenocortical suppression 2
• For steroid-dependent nephrotic syndrome where alternate-day therapy is ineffective, daily prednisolone at the lowest effective dose may be used 2
• Recent evidence suggests split dosing (2/3 morning, 1/3 evening) may achieve faster remission in nephrotic syndrome relapses compared to single dosing 5
• During upper respiratory infections in children with frequently relapsing or steroid-dependent nephrotic syndrome, daily prednisolone may be given to prevent relapse 2

Important Monitoring and Precautions

• Assess for steroid-related adverse effects regularly, especially with prolonged use 2
• Monitor growth in children on long-term therapy 2
• Consider corticosteroid-sparing agents for children with frequent relapses or steroid dependence who develop steroid-related adverse effects 2
• Bone mineral densitometry should be considered for patients on long-term treatment 2

Special Considerations

• Prednisolone and prednisone are equivalent and used in the same dosage 2
• For bronchiolitis, corticosteroids are not recommended as systematic reviews have not shown sufficient evidence to support their use 6
• When discontinuing long-term therapy, gradual tapering is recommended rather than abrupt cessation 1