What is the recommended dosage and duration of prednisone (corticosteroid) therapy for a 14-year-old?

Prednisone Therapy Pack for a 14-Year-Old

For a 14-year-old requiring prednisone therapy, the standard initial dose is 1-2 mg/kg/day (maximum 60 mg/day) administered as a single morning dose, with the specific dosing and duration determined by the underlying condition being treated. 1, 2

Weight-Based Dosing Calculation

• For a typical 14-year-old weighing approximately 50-60 kg, the initial dose would be 50-60 mg/day (at the maximum threshold) 1, 2
• If the adolescent is significantly overweight, calculate the dose based on ideal body weight rather than actual weight to avoid excessive steroid exposure 1, 3, 2
• Administer the entire daily dose as a single morning dose to minimize adrenal axis suppression 3, 2

Condition-Specific Dosing Protocols

For Acute Conditions (Asthma Exacerbations)

• 1-2 mg/kg/day (maximum 60 mg/day) for 3-10 days 2
• No tapering is required for courses less than 7 days 2
• For a 60 kg adolescent, this equals the maximum 60 mg/day 1

For Autoimmune Conditions (Nephrotic Syndrome, Autoimmune Hepatitis)

• Initial dose: 2 mg/kg/day or 60 mg/m²/day (maximum 60 mg/day) as a single daily dose 1, 3, 2
• Continue for 4-6 weeks at this dose 3, 2
• Transition to alternate-day dosing: 1.5 mg/kg/dose or 40 mg/m²/dose (maximum 40 mg on alternate days) 1, 3
• For a 60 kg adolescent, this equals 40 mg every other day 1

Tapering Schedule for Prolonged Therapy

For courses longer than 10 days, implement a gradual taper: 1, 2

• Reduce by 5 mg every week until reaching 10 mg/day 1, 2
• Then reduce by 2.5 mg/week until reaching maintenance dose 1, 2
• Alternative tapering: reduce by 25-33% at appropriate intervals, with final reduction of 1 mg monthly 3

Critical Monitoring Requirements

Bone Health Protection

• Initiate calcium and vitamin D supplementation immediately when starting steroid therapy 3
• Perform baseline and annual bone mineral density testing of lumbar spine and hip for long-term therapy 2
• Consider osteoporosis risk assessment, particularly for high-dose therapy (≥30 mg daily for ≥30 days or cumulative dose ≥5 g over 1 year) 4

Adverse Effect Surveillance

• Monitor regularly for steroid-related side effects, especially with prolonged use 1, 3, 2
• Common effects include Cushingoid features, growth deceleration, weight gain, hypertension, and gastric irritation 3
• Cosmetic changes occur in 80% of patients after 2 years of treatment 1
• Severe side effects are uncommon but more likely after prolonged therapy (>18 months) 1

Growth Monitoring

• Track linear growth in adolescents on long-term therapy 2
• Growth suppression is a significant concern in this age group

Steroid-Sparing Strategies

If side effects become problematic or prolonged therapy is anticipated, consider adding steroid-sparing agents: 1

• Azathioprine 1-2 mg/kg/day reduces corticosteroid-related side effects compared to prednisone monotherapy 3, 2
• Mycophenolate mofetil 2-3 g per day as an alternative 4
• Combination therapy allows for lower prednisone maintenance doses (0.1-0.2 mg/kg/day or 5 mg/day) 2

Important Clinical Caveats

• Do not use systemic corticosteroids for bronchiolitis in patients under 2 years of age (insufficient evidence of benefit) 2
• For adolescents with closed growth plates, additional treatment options may be considered for specific conditions 4
• Avoid abrupt discontinuation after prolonged therapy to prevent adrenal insufficiency
• The combination of prednisone with azathioprine significantly reduces corticosteroid-related side effects 2