Pediatric Prednisolone Dosing Guidelines

General Dosing Principles

The American Journal of Kidney Diseases recommends that for significantly overweight children, dosing should be based on ideal body weight to avoid unnecessary steroid exposure 1
The maximum daily dose is typically 60 mg, though in some cases up to 80 mg may be considered for specific conditions, as recommended by the American Journal of Kidney Diseases 1, 2

The Kidney International guidelines recommend a first episode treatment of 60 mg/m²/day or 2 mg/kg/day (maximum 60 mg/day) as a single daily dose for 4-6 weeks, followed by 40 mg/m²/day or 1.5 mg/kg/day (maximum 40 mg) on alternate days for 2-5 months with tapering 3
The American Journal of Kidney Diseases recommends that for infrequent relapses, 60 mg/m²/day or 2 mg/kg/day (maximum 60 mg/day) should be given until remission for at least 3 days, then 40 mg/m²/day or 1.5 mg/kg/day on alternate days for at least 4 weeks 1, 4
For frequent relapses/steroid-dependent cases, the American Journal of Kidney Diseases suggests daily prednisolone until remission for 3 days, followed by alternate-day prednisolone for at least 3 months at the lowest effective dose 1, 5

The Hepatology guidelines recommend an initial regimen of 1-2 mg/kg/day (maximum 60 mg/day) for two weeks, either alone or with azathioprine, for the treatment of autoimmune hepatitis 6
For maintenance, the Hepatology guidelines suggest tapering over 6-8 weeks to 0.1-0.2 mg/kg/day or 5 mg/day 6

The Kidney International guidelines recommend that for most conditions, prednisolone is administered as a single daily dose in the morning to minimize adrenocortical suppression 3
The American Journal of Kidney Diseases suggests that for steroid-dependent nephrotic syndrome where alternate-day therapy is ineffective, daily prednisolone at the lowest effective dose may be used 1, 2
During upper respiratory infections in children with frequently relapsing or steroid-dependent nephrotic syndrome, the American Journal of Kidney Diseases recommends that daily prednisolone may be given to prevent relapse 1, 5

The American Journal of Kidney Diseases recommends assessing for steroid-related adverse effects regularly, especially with prolonged use 5
The Hepatology guidelines suggest monitoring growth in children on long-term therapy 6
The American Journal of Kidney Diseases recommends considering corticosteroid-sparing agents for children with frequent relapses or steroid dependence who develop steroid-related adverse effects 4
The Hepatology guidelines suggest that bone mineral densitometry should be considered for patients on long-term treatment 6

The Kidney International guidelines state that prednisolone and prednisone are equivalent and used in the same dosage 3