What is the recommended dose of prednisone (corticosteroid) for a 16-year-old requiring a burst?

Prednisone Burst Dosing for a 16-Year-Old

For a 16-year-old requiring a prednisone burst, administer 40-60 mg daily as a single dose or in 2 divided doses for 3-10 days, with no need to taper for courses under 10 days. 1

Specific Dosing Recommendations

Standard Burst Regimen

• Dose: 40-60 mg/day for adolescents ≥12 years of age 1
• Duration: 3-10 days 1
• Administration: Can be given as a single daily dose or divided into 2 doses 1
• No taper required: For courses ≤10 days, tapering is unnecessary, especially if the patient is concurrently taking inhaled corticosteroids 1

Weight-Based Dosing Alternative

• If using weight-based dosing: 1-2 mg/kg/day with a maximum of 60 mg/day 1
• For a typical 16-year-old weighing ≥40 kg, this calculation would reach the 60 mg maximum 2
• Dosing should be based on ideal body weight if the patient is significantly overweight to avoid unnecessary steroid exposure 2, 3

Clinical Context and Indications

Most Common Use: Asthma Exacerbations

• The National Heart, Lung, and Blood Institute guidelines specifically recommend 40-60 mg/day for outpatient bursts in patients ≥12 years 1
• This regimen is effective for establishing control when initiating therapy or during periods of gradual deterioration 1
• No advantage exists for higher doses in asthma exacerbations 1

Alternative Corticosteroid Options

• Dexamethasone can be considered as an alternative: 0.3-0.6 mg/kg daily for 1-2 days 4, 5
• A 2-day course of dexamethasone (16 mg daily) is at least as effective as 5 days of prednisone (50 mg daily) for returning patients to normal activity 5
• Single-dose dexamethasone (0.6 mg/kg, maximum 18 mg) may improve compliance compared to multi-day prednisone courses 6

Important Clinical Considerations

Short-Term Side Effects

• Common adverse effects include reversible abnormalities in glucose metabolism, increased appetite, fluid retention, weight gain, mood alteration, hypertension, insomnia, and facial flushing 1
• These effects are generally well-tolerated and resolve after discontinuation 1

When NOT to Taper

• Courses <1 week: No taper needed 1
• Courses up to 10 days: Probably no need to taper, especially if patient is on inhaled corticosteroids 1

Monitoring and Follow-Up

• Ensure the patient has appropriate follow-up to assess response 1
• Consider coexisting conditions that could be worsened by systemic corticosteroids (e.g., diabetes, hypertension, peptic ulcer) 1
• No advantage for IV administration over oral therapy if gastrointestinal absorption is intact 1

Common Pitfalls to Avoid

• Don't routinely taper short bursts: This is unnecessary and not evidence-based for courses ≤10 days 1
• Don't exceed 60 mg/day: Higher doses provide no additional benefit and increase side effect risk 1
• Don't dose obese patients on actual body weight: Use ideal body weight to prevent excessive steroid exposure 2, 3
• Don't forget to initiate or continue inhaled corticosteroids: These can be started at any point during treatment of an exacerbation 1