Prednisolone Dosing for Croup
For mild-to-moderate croup in children, give oral prednisolone 1 mg/kg as a single dose, though dexamethasone is the preferred corticosteroid for this condition. 1
Evidence-Based Dosing Recommendation
The standard prednisolone dose for croup is 1 mg/kg given as a single oral dose. 1, 2, 3, 4
This dosing has been validated in multiple randomized trials comparing prednisolone to dexamethasone, consistently using the 1 mg/kg dose. 5, 4
For a liquid formulation, use prednisolone 15 mg/5 mL suspension and calculate the volume based on the child's weight (e.g., a 14 kg child would receive approximately 4.7 mL). 1
Important Clinical Considerations
Dexamethasone vs Prednisolone
Dexamethasone 0.15 mg/kg is the preferred first-line corticosteroid for croup because it has superior efficacy in reducing unscheduled re-presentations to medical care. 5
In a head-to-head equivalence trial, prednisolone 1 mg/kg resulted in 29% re-presentation rate compared to only 7% with dexamethasone 0.15 mg/kg—a clinically significant 22% difference. 5
However, when prednisolone is the only available option or when liquid formulation is needed for a child who cannot swallow tablets, the 1 mg/kg dose remains effective for reducing croup symptoms and hospital admissions. 1, 2
Administration Pearls
Use liquid formulation when available as it is more readily absorbed than tablets, particularly important if the child has difficulty swallowing or is at risk of vomiting. 1
No tapering is required for single-dose or short courses under 7 days. 1
Administer as soon as croup is diagnosed and reassess in 1 hour. 3
Severe Croup Protocol
For severe or life-threatening croup with significant respiratory distress, give nebulized epinephrine 0.5 mL/kg of 1:1000 solution (maximum 5 mL) first, then administer corticosteroids and arrange immediate hospital transfer. 1, 3
In severe croup requiring intubation, oral prednisolone 1 mg/kg every 12 hours decreases the duration of intubation and need for re-intubation. 2
Common Pitfall
Avoid using prednisolone 2 mg/kg for 3 days (a regimen tested in one community trial) as this multi-day course showed no advantage over single-dose dexamethasone and creates unnecessary compliance issues. 6
The single 1 mg/kg dose eliminates compliance problems inherent with multi-day courses while providing effective symptom reduction. 1