From the Research
For children with fulminant myocarditis, intravenous methylprednisolone (Solumedrol) is typically administered at a dose of 10-30 mg/kg/day (maximum 1 gram per day) for 1-3 days, followed by a gradual taper over 2-4 weeks, as supported by the most recent study 1. The initial high-dose pulse therapy is often given once daily, divided into 1-2 doses. After the initial pulse therapy, transition to oral prednisone at 1-2 mg/kg/day (maximum 60 mg/day), with a gradual taper by reducing the dose by approximately 10-20% every 3-7 days based on clinical response, as seen in the study 1. Some key points to consider in the treatment of fulminant myocarditis in children include:
- Close monitoring of vital signs, cardiac function, and electrolytes is essential during treatment.
- Potential side effects include hyperglycemia, hypertension, mood changes, and increased susceptibility to infections, so blood glucose monitoring and blood pressure checks should be performed regularly.
- Corticosteroids like methylprednisolone work by suppressing the inflammatory response and immune system activation that contribute to myocardial damage in fulminant myocarditis.
- This treatment should be part of a comprehensive approach that may include supportive care, inotropic support, and other immunomodulatory therapies depending on the severity and etiology of the myocarditis, as discussed in 2 and 1. The use of high-dose steroids in conjunction with IVIG has been shown to be safe and effective in treating acute myocarditis in children, with excellent recovery of ventricular function and survival without transplant, as reported in 1. However, it is essential to note that the specific treatment approach may vary depending on the individual case and the underlying cause of the myocarditis, and should be guided by the most recent and highest-quality evidence available, such as the study published in 1.