What is the recommended prednisone (corticosteroid) dosing for a 14-year-old patient with bronchitis?

Prednisone Dosing for a 14-Year-Old with Bronchitis

Prednisone is not recommended for acute bronchitis in a 14-year-old patient, as systemic corticosteroids have no proven benefit in this condition and should not be used routinely. 1

Key Distinction: Acute Bronchitis vs. Other Conditions

The critical first step is determining what type of "bronchitis" you're treating, as this fundamentally changes management:

Acute Bronchitis (Most Common)

• No steroids indicated - The clinical course is self-limited, resolving spontaneously in approximately 10 days, though cough may persist longer 1
• Purulent sputum does NOT indicate bacterial superinfection and does not justify steroid treatment 1
• Antibiotics are also not recommended for acute bronchitis in otherwise healthy patients 1

Protracted Bacterial Bronchitis (Chronic Wet Cough)

If the 14-year-old has had a wet/productive cough for >4 weeks without underlying disease:

• Antibiotics, not steroids, are the treatment of choice 2
• Recommend 2 weeks of antibiotics targeting common respiratory bacteria (Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis) 2
• If cough persists after 2 weeks of appropriate antibiotics, extend treatment for an additional 2 weeks 2
• Corticosteroids are not part of the management algorithm for protracted bacterial bronchitis 2

Asthma Exacerbation (Misdiagnosed as "Bronchitis")

If the patient actually has asthma presenting with cough and wheezing:

• Prednisone 1-2 mg/kg/day (maximum 60 mg/day) for 3-10 days is appropriate 2
• This is typically 40-60 mg daily as a single dose or divided into 2 doses 2

Postinfectious Cough

If cough has persisted 3-8 weeks following an acute respiratory infection:

• First-line: Consider inhaled ipratropium 2
• Second-line: Inhaled corticosteroids if cough adversely affects quality of life and persists despite ipratropium 2
• For severe paroxysms only: Prednisone 30-40 mg/day for a short, finite period after ruling out other common causes (upper airway cough syndrome, asthma, GERD) 2

Common Pitfalls to Avoid

• Mistaking acute bronchitis for asthma exacerbation - The presence of wheezing alone does not justify steroids in acute bronchitis 1
• Prescribing steroids based on purulent sputum - This is not an indication for steroid therapy in acute bronchitis 1
• Using steroids to shorten illness duration - Evidence shows no benefit for this purpose in acute bronchitis 1
• Confusing bronchiolitis (age <2 years) with bronchitis - Bronchiolitis also does not benefit from steroids 3, 4

Clinical Algorithm

1. Duration <3 weeks with acute onset: Acute bronchitis → No steroids, supportive care only 1
2. Duration >4 weeks with wet cough: Protracted bacterial bronchitis → Antibiotics, not steroids 2
3. History of asthma with wheezing: Asthma exacerbation → Prednisone 1-2 mg/kg/day 2
4. Duration 3-8 weeks post-infection with severe paroxysms: Postinfectious cough → Consider prednisone 30-40 mg/day only after other causes ruled out 2