Oral Dosage of Methylprednisolone for Pediatric Patients
The oral dosage of methylprednisolone for pediatric patients is 0.25-2 mg/kg/day, with a maximum of 60 mg daily, depending on the condition being treated. 1
General Dosing Guidelines
- For children 0-4 years of age, methylprednisolone is dosed at 0.25-2 mg/kg daily 1
- For children 5-11 years of age, methylprednisolone is dosed at 0.25-2 mg/kg daily 1
- Short-course burst therapy (for conditions like asthma exacerbations) typically uses 1-2 mg/kg/day for 3-10 days 1
- The maximum daily dose is generally 60 mg for pediatric patients 1
Condition-Specific Dosing
Asthma Management
- For asthma exacerbations requiring short-course therapy: 1-2 mg/kg/day for 3-10 days 1
- For maintenance therapy in severe persistent asthma: administer single dose in AM either daily or on alternate days (alternate-day therapy may produce less adrenal suppression) 1
- In critically ill asthmatic children, higher doses (2-4 mg/kg/day) are sometimes used based on clinical experience, though this exceeds guideline recommendations 2
Multisystem Inflammatory Syndrome in Children (MIS-C)
- Initial therapy: IV 1-2 mg/kg/day 1
- For intensification treatment in refractory cases: IV 10-30 mg/kg/day 1
Other Inflammatory Conditions
- For children with histoplasmosis: 2.0 mg/kg daily given intravenously 1
- For children with nephrotic syndrome: similar to prednisolone dosing of 2 mg/kg/day (maximum 60 mg/day) 3
Administration Considerations
- For most conditions, corticosteroids should be administered as a single daily dose in the morning to minimize adrenocortical suppression 3
- Short courses or bursts do not require tapering after improvement in symptom control and pulmonary function 1
- For long-term treatment of severe persistent conditions, consider alternate-day therapy to reduce adrenal suppression 1
Potential Adverse Effects
- Short-term use: reversible abnormalities in glucose metabolism, increased appetite, fluid retention, weight gain, mood alteration, hypertension 1
- Long-term use: adrenal axis suppression, growth suppression, dermal thinning, hypertension, diabetes, Cushing syndrome, cataracts, muscle weakness, and in rare instances, impaired immune function 1
- Special consideration should be given to coexisting conditions that could be worsened by systemic corticosteroids, such as herpes virus infections, varicella, tuberculosis, hypertension, peptic ulcer, diabetes mellitus, osteoporosis, and Strongyloides 1
Route of Administration Considerations
- For hospitalized children with asthma, oral prednisone (2 mg/kg/dose, maximum 120 mg/dose, twice daily) has been shown to be as effective as intravenous methylprednisolone (1 mg/kg/dose, maximum 60 mg/dose, four times daily) 4
- Oral administration is more cost-effective than intravenous administration when gastrointestinal absorption is not impaired 4
Dosing in Overweight Children
- For significantly overweight children, dosing should be based on ideal body weight to avoid unnecessary steroid exposure 3