From the Guidelines
The recommended dose of prednisone for treating croup is not directly supported by the provided evidence, but based on general medical knowledge, a dose of 1-2 mg/kg is often used, with a typical maximum dose of 60 mg, however, the evidence provided suggests a daily single dose of 1 mg/kg (maximum 80 mg) or alternate-day single dose of 2 mg/kg (maximum 120 mg) for glomerulonephritis 1. When considering the treatment of croup, it's essential to prioritize the reduction of inflammation in the upper airway to improve symptoms.
- The medication works by reducing inflammation, particularly in the subglottic region where croup causes narrowing and the characteristic "barking" cough.
- This anti-inflammatory effect helps decrease airway edema, improves breathing, and reduces the severity of symptoms, typically within 2-3 hours after administration.
- The benefits generally last for 24-48 hours.
- For severe cases or when symptoms persist, a second dose may be considered after 24 hours, but this should be determined by a healthcare provider.
- Prednisone should be administered with food to minimize gastrointestinal side effects, and parents should be advised that children may experience temporary behavioral changes, increased appetite, or sleep disturbances. It's crucial to note that the provided evidence is related to glomerulonephritis, not croup, but in real-life clinical practice, the dose of 1-2 mg/kg is often used for croup, and the evidence from 1 should not be directly applied to croup treatment without considering the context and potential side effects.
From the Research
Dosing for Prednisone in Treating Croup
- The dosing for prednisone in treating croup is not directly stated in most of the provided studies, which primarily focus on the use of racemic epinephrine, dexamethasone, and other treatments for croup 2, 3, 4.
- However, one study compares single-dose oral prednisolone with oral dexamethasone in the treatment of croup, using a dose of 1 mg/kg of oral prednisolone 5.
- Another study mentions that dexamethasone IM, or an equivalent dose of oral prednisone, may be considered in children with moderately severe croup who do not require hospitalization, but does not specify the exact dosage of prednisone 6.
- It is essential to note that the correct dosage of corticosteroids, such as dexamethasone or prednisone, is crucial in treating croup, as lower steroid dosages have proven to be ineffective 6.
Key Considerations
- The treatment of croup often involves the use of corticosteroids, such as dexamethasone or prednisone, to decrease obstructive symptoms 6.
- Racemic epinephrine may be used to quickly reverse airway obstruction in children with croup, but its effects are transient, and corticosteroids are necessary for long-term symptom relief 2, 6.
- The decision to hospitalize a child with croup depends on various factors, including the severity of symptoms, response to treatment, and the need for ongoing monitoring and care 3, 4.