Pediapred (Prednisolone) is NOT Recommended for Routine Upper Respiratory Infections in Children
Prednisolone should not be prescribed for uncomplicated upper respiratory infections in otherwise healthy children, as there is no evidence of benefit and it exposes children to unnecessary corticosteroid side effects.
Clinical Context and Evidence
The question appears to conflate two distinct clinical scenarios that require clarification:
For Otherwise Healthy Children with URI
- No role for prednisolone exists in treating routine upper respiratory infections in healthy children 1
- Antibiotic treatment of uncomplicated viral upper respiratory tract infections is inappropriate and strongly discouraged 2
- Upper respiratory infections in children are typically self-limiting viral conditions that do not benefit from corticosteroid therapy 1
For Children with Virus-Induced Wheezing
- Oral prednisolone is NOT effective for preschool children (10 months to 6 years) presenting with acute virus-induced wheezing associated with upper respiratory infections 3
- A large randomized controlled trial of 687 children found no significant difference in hospitalization duration (13.9 hours vs 11.0 hours, p=0.77) or any secondary outcomes between prednisolone (10-20 mg daily for 5 days) and placebo 3
- This contradicts the widespread practice of using short-course prednisolone for viral wheezing in this age group 3
For Children with Nephrotic Syndrome (Special Population Only)
This is the ONLY pediatric population where prednisolone during URI has been studied, but recent evidence shows:
- The 2025 KDIGO guidelines now recommend AGAINST routine daily glucocorticoids during upper respiratory tract infections for children with frequently relapsing or steroid-dependent nephrotic syndrome (Grade 1C recommendation) 2
- This represents a major change from older 2013 guidelines that suggested daily prednisone during URIs for this population 2
- The change was based on the PREDNOS2 trial (2022), which enrolled 271 children and found that 6 days of prednisolone 15 mg/m²/day at URI onset showed no difference in relapse rates compared to placebo (42.7% vs 44.3%, adjusted risk difference -0.02, p=0.70) 4, 5, 6
The only remaining indication is for highly selected children with nephrotic syndrome already on alternate-day prednisolone who have both: (1) history of repeated infection-associated relapses AND (2) significant prednisolone-related morbidity. In this narrow scenario, 3 extra doses of 0.5 mg/kg/day can be considered 2
Critical Pitfalls to Avoid
- Do not prescribe prednisolone for routine pediatric URIs - this represents inappropriate corticosteroid use with potential for adverse effects including growth suppression, immunosuppression, and behavioral changes 7
- Do not confuse URI treatment with other conditions - if the child has streptococcal pharyngitis, the appropriate treatment is amoxicillin 50-75 mg/kg/day divided twice daily for 10 days, NOT prednisolone 8
- Do not use outdated nephrotic syndrome protocols - the 2025 KDIGO guidelines supersede older recommendations that suggested routine prednisolone during URIs for children with nephrotic syndrome 2
Appropriate URI Management in Children
For uncomplicated viral upper respiratory infections:
- Supportive care with adequate hydration and antipyretics as needed 1
- Antibiotics only if bacterial superinfection is documented (e.g., acute bacterial rhinosinusitis with purulent drainage lasting ≥10 days, or confirmed streptococcal pharyngitis) 2, 1
- No role for systemic corticosteroids in otherwise healthy children 3