Oral Prednisolone Dosing for Croup in a 60-Pound Pediatric Patient
For a 60-pound (27 kg) child with croup, administer oral prednisolone 1 mg/kg as a single dose (27 mg), though dexamethasone 0.15 mg/kg (4 mg) is the preferred corticosteroid based on superior efficacy data.
Primary Recommendation: Dexamethasone Over Prednisolone
While you specifically asked about prednisolone dosing, the evidence strongly favors dexamethasone for croup treatment:
- Dexamethasone demonstrates superior clinical outcomes compared to prednisolone, with significantly fewer return visits to medical care (7% vs 29% re-presentation rate) 1
- The FDA-approved dosing for pediatric respiratory conditions supports corticosteroid use at 1-2 mg/kg/day for acute exacerbations 2
- A Cochrane systematic review of 45 RCTs confirms glucocorticoids are effective for croup, with dexamethasone showing approximately 45% reduction in return visits or readmissions compared to prednisolone 3
If Prednisolone Must Be Used
Administer 1 mg/kg as a single oral dose (27 mg for this 60-pound child) 4, 1
Dosing Details:
- Single dose administration: Give 27 mg orally once 1
- No tapering required: Short courses under 7 days do not suppress the adrenal axis 5
- Timing: Can be given immediately upon diagnosis 4
Evidence Supporting This Dose:
- Historical data from severe croup requiring intubation used prednisolone 1 mg/kg every 12 hours, but current practice favors single-dose therapy 4
- A community-based RCT used prednisolone 2 mg/kg/day for 3 days, but this multi-dose regimen showed no advantage over single-dose dexamethasone 6
- The single 1 mg/kg dose represents the minimum effective dose based on available evidence 1
Critical Clinical Caveat
Prednisolone is demonstrably inferior to dexamethasone for croup. A double-blind RCT showed prednisolone resulted in a 22% higher rate of unscheduled return to medical care (confidence interval 8-35%), which exceeded the equivalence threshold 1. Another community trial found no significant differences between treatments, but this study used a higher prednisolone dose (2 mg/kg/day for 3 days) 6.
Why Dexamethasone Is Preferred
- Longer half-life: 36-72 hours versus 12-36 hours for prednisolone, ensuring sustained anti-inflammatory effect 7
- Single-dose convenience: Eliminates compliance issues with multi-day regimens 7
- Lower return visit rates: Proven reduction in healthcare re-utilization 1, 3
- Established efficacy: Dexamethasone 0.15 mg/kg (4 mg for this child) is as effective as higher 0.6 mg/kg doses 3
Practical Administration
For this 60-pound (27 kg) child:
- If using prednisolone: 27 mg orally once (can use commercially available liquid formulation) 1
- Better option - dexamethasone: 4 mg orally once (0.15 mg/kg) 3
- Maximum dose consideration: The 27 mg prednisolone dose is well below the 60 mg maximum for pediatric use 2
Monitoring
- No routine tapering needed for single-dose or short courses 5
- Advise parents about potential return visit needs, particularly if prednisolone is used instead of dexamethasone 1
- Minimal adverse effects expected from single-dose therapy; severe varicella infection is the only significant concern with short corticosteroid courses 4