Prednisone Dosing for Severe Alcoholic Hepatitis with Maddrey Score of 110
For patients with a Maddrey score of 110, prednisolone 40 mg daily for 28 days is the recommended treatment, typically followed by discontinuation or a 2-week taper. 1
Dosing Recommendations
- Prednisolone 40 mg daily (or prednisone equivalent) for 28 days is the standard dosing regimen for severe alcoholic hepatitis (Maddrey score ≥32) 1
- A Maddrey score of 110 represents very severe disease, well above the threshold of 32 that defines severe alcoholic hepatitis requiring corticosteroid therapy 1
- The treatment should be initiated after systematic evaluation for contraindications, which may take up to a week 2
- After the 28-day treatment period, options include:
Monitoring Response to Treatment
- Calculate the Lille score on day 7 of treatment to identify responders vs. non-responders 1
- Patients with a Lille score ≥0.45 are considered non-responders 1
- For patients with a Lille score ≥0.56, corticosteroid therapy should be discontinued 1
- Response to therapy is a critical predictor of short-term survival 1
Infection Risk Management
- Perform extensive bacteriological examination (urine, ascites fluid, blood cultures) before initiating corticosteroid therapy 1
- Monitor closely for infections, particularly during the first month of treatment 2
- Recent evidence suggests that a tapered prednisolone regimen (starting at 40 mg/day and tapering by 10 mg/day every week over 4 weeks) may reduce infection risk compared to fixed dosing 3
Alternative Treatments
- For patients with contraindications to steroids (uncontrolled infection, severe digestive hemorrhage), pentoxifylline 400 mg orally three times daily for 4 weeks can be considered 1
- Pentoxifylline is particularly beneficial in preventing hepatorenal syndrome but is generally less effective than prednisolone for overall survival 4, 5
Nutritional Support
- All patients should receive aggressive nutritional therapy alongside medical treatment 1
- Enteral nutritional therapy should be provided, particularly for patients with severe disease 1
- Frequent interval feedings with emphasis on nighttime snacks should be implemented 1
Important Considerations
- Complete alcohol abstinence is essential and should be strongly recommended 1
- The combination of prednisolone and pentoxifylline has not shown improved 6-month survival compared to prednisolone alone 5
- Mortality remains high despite treatment, with a 6-month survival rate of approximately 70-80% in responders to corticosteroid therapy 1