What is the recommended dose of prednisone (corticosteroid) for an 11-year-old patient weighing 115 pounds (52 kg) with bronchitis?

Prednisone Dosing for Viral Bronchitis in an 11-Year-Old

Prednisone should NOT be given for viral bronchitis in this child unless there is documented evidence of asthma with recurrent wheezing episodes. 1

Key Clinical Decision Point

The critical distinction is between viral bronchitis (a single, self-limiting illness) and asthma exacerbation:

• Viral bronchitis is characterized by acute cough, wheeze, and crackles following an upper respiratory infection, typically resolving within 8-15 days in 90% of children 1
• Asthma exacerbation requires recurrent episodes of wheeze and/or dyspnea (≥3 episodes), not just a single viral illness 1

When Prednisone is NOT Indicated

For a previously healthy child with their first episode of bronchitis, systemic corticosteroids should be avoided. 1 The American College of Chest Physicians explicitly recommends against routine corticosteroid administration to children with viral bronchitis unless there is clear evidence of asthma 1. Research confirms that a 3-day course of oral corticosteroids provides no benefit to children with bronchiolitis/bronchitis when added to bronchodilator therapy 2.

Appropriate Management Without Steroids:

• Supportive care with hydration and monitoring 1
• Trial of bronchodilators (albuterol) for symptomatic relief 1
• Observation for spontaneous resolution within 8-15 days 1

When Prednisone IS Indicated

If this child has documented recurrent wheeze (≥3 episodes) or dyspnea and wheeze beyond a single viral illness, indicating asthma rather than simple bronchitis, then prednisone is appropriate 1:

Dosing for Asthma Exacerbation:

• Standard dose: 1-2 mg/kg/day with a maximum of 60 mg/day 1, 3
• For this 115 lb (52 kg) child: 52-104 mg daily 1
• Practical dose: Start with 60 mg daily (approximately 1.2 mg/kg/day) as a single morning dose 1
• Duration: 3-10 days for acute exacerbations 1
• No tapering needed for courses less than 10 days, especially if the child is on inhaled corticosteroids 1

Important Caveats

Do not prescribe prednisone based solely on current symptoms. 1 The presence of cough and wheeze during a viral illness does not automatically warrant corticosteroid therapy. You must establish whether this represents:

1. A first-time viral bronchitis (no steroids indicated) 1
2. A pattern of recurrent wheezing suggesting asthma (steroids indicated) 1

Short-term Side Effects to Monitor:

• Increased appetite, mood changes, hyperglycemia, and hypertension (generally well-tolerated and reversible) 1
• No routine monitoring needed for short courses under 10 days 1
• Consider coexisting conditions that could worsen with steroids (diabetes, hypertension, peptic ulcer) 1