What is the recommended dosage of prednisolone (Prednisolone) for pediatric (peds) patients with enlarged tonsils?

From the Guidelines

For enlarged tonsils in children, prednisolone is typically prescribed at a dosage of 1-2 mg/kg/day (maximum 30 mg/day for children under 4 years and 60 mg/day for children 5-11 years) for a short course of 3-10 days. The medication should be given once daily in the morning with food to minimize gastrointestinal side effects. For a child weighing 20 kg, this would mean approximately 20-40 mg daily. Prednisolone works by reducing inflammation in the tonsils, which can help decrease their size and relieve symptoms like difficulty swallowing, breathing problems, or sleep disturbances. Parents should complete the full course as prescribed even if symptoms improve quickly. Side effects may include increased appetite, mood changes, and stomach upset, as noted in the study by 1. It's essential to consider the potential adverse effects of long-term use, such as adrenal axis suppression, growth suppression, and dermal thinning, as mentioned in the study by 1. If symptoms persist or recur frequently, further evaluation by a pediatrician or ENT specialist is recommended to determine if additional treatments or interventions like tonsillectomy might be necessary.

Some key points to consider when prescribing prednisolone for enlarged tonsils in children include:

• The dosage and duration of treatment should be individualized based on the child's age, weight, and response to treatment, as suggested by the study by 1.
• The medication should be given in the morning to minimize gastrointestinal side effects and to help regulate the child's sleep-wake cycle.
• Parents should be advised to monitor their child for potential side effects and to seek medical attention if they experience any severe or persistent symptoms.
• The use of prednisolone for enlarged tonsils in children should be carefully considered, taking into account the potential benefits and risks, as well as the availability of alternative treatments, as discussed in the study by 1.

In terms of the evidence, the study by 1 provides guidance on the dosage and duration of treatment for prednisolone in children with enlarged tonsils. The study recommends a short course of 3-10 days, with a dosage of 1-2 mg/kg/day (maximum 30 mg/day for children under 4 years and 60 mg/day for children 5-11 years). The study also notes the potential adverse effects of long-term use, such as adrenal axis suppression, growth suppression, and dermal thinning. Overall, the evidence suggests that prednisolone can be an effective treatment for enlarged tonsils in children, but it should be used judiciously and with careful consideration of the potential benefits and risks.

From the FDA Drug Label

The range of initial doses is 0. 14 to 2 mg/kg/day in three or four divided doses (4 to 60 mg/m2bsa/day). The National Heart, Lung, and Blood Institute (NHLBI) recommended dosing for systemic prednisone, prednisolone or methylprednisolone in children whose asthma is uncontrolled by inhaled corticosteroids and long-acting bronchodilators is 1–2 mg/kg/day in single or divided doses

The dosage of prednisolone for pediatric patients with enlarged tonsils is not explicitly stated in the drug label. However, based on the provided information, the initial dose of prednisolone sodium phosphate oral solution in pediatric patients may vary depending on the specific disease entity being treated, with a range of 0.14 to 2 mg/kg/day in three or four divided doses. For children, a dose of 1-2 mg/kg/day in single or divided doses is recommended for systemic prednisone, prednisolone, or methylprednisolone in cases of uncontrolled asthma 2. Since the label does not directly address the treatment of enlarged tonsils, no specific dosage can be recommended.

From the Research

Prednisolone Dosage for Pediatric Enlarged Tonsils

There is no direct evidence in the provided studies regarding the specific dosage of prednisolone for pediatric enlarged tonsils.

• The studies focus on the microbiology, risk factors, and treatment of peritonsillar abscess, tonsillar hypertrophy, and streptococcal pharyngitis, but do not provide information on prednisolone dosage for enlarged tonsils in children.
• Study 3 discusses the pharmacological therapy for adenotonsillar hypertrophy, which includes steroids, but does not specify the dosage or type of steroid.
• Study 4 examines the innate immune and inflammatory responses in hypertrophic tonsils, but does not mention steroid treatment or dosage.
• Study 5 establishes normative values for tonsil size in pediatric populations using ultrasonography, but does not address steroid treatment.
• Study 6 explores the microbiology and risk factors of peritonsillar abscess, but does not discuss steroid treatment or dosage.
• Study 7 discusses the treatment of streptococcal tonsillitis/pharyngitis in young children, but focuses on antibiotic treatment and does not mention steroid dosage.

Treatment of Enlarged Tonsils

• The treatment of enlarged tonsils often involves addressing the underlying cause, such as infection or allergy, and may include antibiotics, local vasoconstrictors, or other medications.
• In some cases, surgical intervention, such as tonsillectomy, may be necessary to remove the enlarged tonsils.
• Study 3 suggests that adenoidectomy, especially when combined with tonsillectomy, can lead to the resolution of symptoms, but may not always result in the normalization of functional alterations.

Steroid Treatment

• Steroids, such as prednisolone, may be used to reduce inflammation and swelling in the tonsils, but the dosage and duration of treatment would depend on the specific condition and the child's response to treatment.
• Study 3 mentions that pharmacological therapy, including steroids, has a purely palliative function and is based on antibiotics, local vasoconstrictors, steroids, and theophylline.