Prednisolone Dosing for Croup in Children
For children with croup, the recommended dose of prednisolone is 1 mg/kg/day as a single daily dose (maximum 60 mg/day). 1
Dosing Guidelines
- Prednisolone and prednisone are equivalent medications and can be used interchangeably at the same dosage 2
- For croup treatment, the typical dosing range is 1-2 mg/kg/day (maximum 60 mg/day) 1
- The FDA label for prednisolone indicates that pediatric dosing may vary from 0.14 to 2 mg/kg/day depending on the specific condition being treated 1
- For significantly overweight children, dosing should be based on ideal body weight to avoid unnecessary steroid exposure 3, 2
Administration Considerations
- Prednisolone is typically administered as a single daily dose in the morning to minimize adrenocortical suppression 3
- While a single dose is often sufficient for croup, some clinicians may prescribe a short course (1-3 days) 4
- Oral administration is preferred due to ease of administration and better tolerability 1
Comparative Effectiveness
- Research has compared prednisolone to dexamethasone for croup treatment:
- A community-based randomized trial found no significant differences between prednisolone (2 mg/kg/day for 3 days) and a single dose of dexamethasone (0.6 mg/kg) in terms of additional healthcare needs, duration of symptoms, or parental stress 4
- However, another study found that children treated with prednisolone (1 mg/kg) were more likely to re-present for medical care compared to those receiving dexamethasone (0.15 mg/kg), suggesting that dexamethasone may be more effective 5
Clinical Considerations
- Corticosteroids have become the standard of care for moderate-to-severe croup, showing benefits in reducing hospitalizations and shortening illness duration 6
- For mild croup, lower doses of corticosteroids may be considered, though some clinicians use the same dosing regardless of severity 6
- Corticosteroid-induced complications in croup treatment are rare 6
- The National Heart, Lung, and Blood Institute recommends continuing "burst therapy" until symptoms resolve, which usually requires 3-10 days of treatment 1
Common Pitfalls and Caveats
- There is no evidence that tapering the dose after improvement will prevent a relapse 1
- Antihistamines, decongestants, and antibiotics have no proven effect on uncomplicated viral croup 7
- Monitor for steroid-related adverse effects, especially with prolonged use, though these are uncommon with short-course therapy for croup 8
- In severe croup requiring intubation, a higher dose of prednisolone (1 mg/kg every 12 hours) may be needed 9
While both prednisolone and dexamethasone are effective for croup, some evidence suggests dexamethasone may have advantages in terms of reducing re-presentation rates. However, prednisolone remains an appropriate choice, particularly when dexamethasone is unavailable in liquid form.