Recommended Prednisone Dosing for Croup in Children
For children with croup, the recommended dose of prednisone is 1-2 mg/kg/day as a single daily dose (maximum 60 mg). 1, 2
Dosing Guidelines
- Prednisone and prednisolone are equivalent medications and can be used interchangeably at the same dosage 1, 2
- For significantly overweight children, dosing should be based on ideal body weight to avoid unnecessary steroid exposure 1, 2
- A single dose is typically sufficient for most cases of mild to moderate croup 3
- Maximum daily dose is typically 60 mg, even for larger children 1
Evidence for Corticosteroid Use in Croup
- Corticosteroids have become the standard of care for moderate-to-severe croup, showing reduced hospitalizations and shorter duration of illness 4
- While dexamethasone (0.6 mg/kg) is often preferred for croup due to its longer half-life, prednisone at 1 mg/kg has shown effectiveness in treating croup symptoms 5
- A single oral dose of prednisolone/prednisone may be less effective than dexamethasone in preventing return visits for croup symptoms 6
Administration Considerations
- Administer as a single daily dose in the morning to minimize adrenocortical suppression 7
- For mild to moderate croup, a single dose may be sufficient 3
- For more severe cases, a short course of 2-3 days may be considered 3
Monitoring and Precautions
- Monitor for common steroid-related side effects, especially with prolonged use 2
- Side effects are minimal with a single or short course of systemic corticosteroids 5
- The only potential significant adverse effect of a short course is increased risk of severe varicella infection 5
Clinical Pearls
- Antibiotics, antihistamines, and decongestants have no proven effect on uncomplicated viral croup 8
- Adequate hydration, humidification, and fever control are important components of home care 8
- In severe croup requiring more intensive intervention, nebulized epinephrine may be necessary in addition to corticosteroids 8
- For patients unable to tolerate oral medication due to vomiting or severe respiratory distress, intramuscular administration should be considered 4