What is the appropriate dosing of prednisone for a child weighing 60 kilograms?

Prednisone Dosing for a 60 kg (132 lb) Child

For a child weighing 60 kg (132 lb), the appropriate prednisone dose is 2 mg/kg/day (maximum 60 mg/day) for initial therapy, which equals 60 mg/day as a single daily dose. 1, 2

General Dosing Principles

• Prednisone and prednisolone are equivalent medications and can be used interchangeably at the same dosage 3, 1
• For significantly overweight children, dosing should be based on ideal body weight to avoid unnecessary steroid exposure 1
• Single daily dosing is recommended, preferably in the morning before 9 am to minimize adrenal suppression 2
• Administration with food or milk can reduce gastric irritation 2

Condition-Specific Dosing

Initial Treatment

• For most conditions requiring high-dose therapy (such as nephrotic syndrome, autoimmune conditions):
  • Initial dose: 2 mg/kg/day or 60 mg/m²/day (maximum 60 mg/day) as a single daily dose 3
  • For a 60 kg child, this equals 60 mg/day (the maximum dose) 1

Maintenance and Tapering

• After initial response (typically 4-6 weeks of daily therapy):
  • Switch to alternate-day dosing at 1.5 mg/kg/dose or 40 mg/m²/dose (maximum 40 mg on alternate days) 3
  • For a 60 kg child, this equals 40 mg every other day 1
• Taper gradually by reducing the dose by 5 mg every week until reaching 10 mg/day, then by 2.5 mg/week until reaching maintenance dose 3

Alternative Dosing Equations

• For estimating BSA-based dosing using only weight:
  • For 60 mg/m² dose: [2 × Weight(kg) + 8] = [2 × 60 + 8] = 128 mg 4
  • For 40 mg/m² dose: [Weight(kg) + 11] = [60 + 11] = 71 mg 4
  • However, these calculated doses exceed maximum recommended doses (60 mg daily and 40 mg alternate day), so the maximum doses should be used 3

Important Monitoring Considerations

• Monitor for steroid-related side effects, especially with prolonged therapy 1
• Common side effects include:
  • Cosmetic changes (facial rounding, striae, weight gain, acne) occur in 80% of patients after 2 years of treatment 3
  • Severe side effects (osteopenia, diabetes, hypertension) are uncommon but more likely after prolonged therapy (>18 months) 3
• For long-term therapy, consider:
  • Baseline and annual bone mineral density testing 3
  • Adding steroid-sparing agents if side effects become problematic 3
  • Combination with azathioprine may reduce corticosteroid-related side effects (10% versus 44%) 3

Caution

• Weight-based dosing (2 mg/kg/day) may result in relative underdosing compared to BSA-based dosing (60 mg/m²/day), particularly in smaller children 5
• This underdosing may not affect initial response but could increase the likelihood of frequent relapses in conditions like nephrotic syndrome 5
• For a 60 kg child, this is less of a concern as they are likely to reach the maximum dose cap of 60 mg/day regardless of calculation method 1