What is the recommended dose and administration of prednisolone (1 mg/ml) for a 12-year-old patient with asthma, weighing 35 kg?

Prednisolone Dosing for a 12-Year-Old with Asthma (35 kg)

For this 12-year-old patient weighing 35 kg, administer 35-70 mL of prednisolone 1 mg/mL oral solution (35-70 mg) daily, given as a single morning dose or divided into two doses, continuing for 3-10 days until symptoms resolve and peak expiratory flow reaches 70% of predicted or personal best. 1, 2, 3

Specific Dosing Calculation

Weight-based dosing:

• The recommended pediatric dose is 1-2 mg/kg/day with a maximum of 60 mg/day 4, 1
• For this 35 kg patient: 35-70 mg daily (35-70 mL of the 1 mg/mL solution) 1, 2
• However, the maximum dose is capped at 60 mg/day regardless of weight calculation 1, 2, 3
• Therefore, give 35-60 mL (35-60 mg) daily 1, 2, 3

Administration Method

Dosing schedule options:

• Give as a single morning dose of 35-60 mL, OR 2
• Divide into two doses: 17.5-30 mL twice daily 4, 1, 2
• The divided dosing approach (twice daily) is specifically recommended in guidelines for optimal effect in children 4, 1

Treatment Duration and Monitoring

Duration algorithm:

• Continue treatment for 3-10 days until peak expiratory flow reaches 70% of predicted or personal best 1, 2, 3
• Most patients require 5-10 days of treatment 1, 2
• No tapering is necessary for courses lasting less than 7-10 days, especially if the patient is on inhaled corticosteroids 1, 2

Critical monitoring points:

• Assess clinical response by measuring peak expiratory flow 15-30 minutes after starting bronchodilator treatment 4
• Continue treatment until symptoms resolve AND peak flow reaches ≥70% of predicted 1, 2

Concurrent Essential Therapy

Must be given alongside prednisolone:

• High-flow oxygen if oxygen saturation <92% 4
• Nebulized salbutamol 5 mg (or 2.5 mg in younger/smaller children) via oxygen-driven nebulizer every 4 hours initially 4
• If not improving after 15-30 minutes, increase bronchodilator frequency to every 30 minutes and add ipratropium 0.5 mg 4

Important Clinical Considerations

Timing is critical:

• Administer prednisolone immediately upon recognition of the asthma exacerbation, as anti-inflammatory effects take 6-12 hours to become apparent 1, 2
• Delay in corticosteroid administration is associated with increased morbidity and mortality 4, 1

Route selection:

• Oral administration is strongly preferred and equally effective as intravenous therapy when the patient can tolerate oral intake 1, 2, 5
• Switch to IV hydrocortisone only if the patient is vomiting, severely ill, or unable to swallow 4, 6

Common Pitfalls to Avoid

Do not:

• Use doses higher than 2 mg/kg/day (60 mg maximum), as higher doses provide no additional benefit but increase adverse effects 1, 2
• Taper the dose for short courses (3-10 days), as this is unnecessary and may lead to underdosing during the critical recovery period 1, 2
• Delay corticosteroid administration while waiting for other interventions or test results 1, 2
• Rely solely on clinical impression without objective peak flow measurements to assess severity and response 4

Ensure:

• The patient continues or starts inhaled corticosteroids at appropriate maintenance doses 1, 2
• Follow-up is arranged within 1 week with the primary care provider and within 4 weeks in a respiratory clinic 4
• The patient/family receives a written self-management plan and peak flow meter if appropriate 4