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Usual Pediatric Dose for Erythema Multiforme. Dosing should be individualized based on disease and patient response with less emphasis on strict adherence to age or body weight dosing: Initial dose: 5 to 60 mg orally per day Maintenance dose: Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response. Comments : -Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 to 8 AM) when dosing. Uses: As an anti-inflammatory or immunosuppressive agent when corticosteroid therapy is appropriate, such as for the treatment of certain allergic states; nervous system, neoplastic, or renal conditions; endocrine, rheumatologic, or hematologic disorders; collagen, dermatologic, ophthalmic, respiratory, or gastrointestinal diseases; specific infectious diseases or conditions related to organ transplantation. Usual Pediatric Dose for Nephrotic Syndrome. Age: 1 year or older: Initial episode: 60 mg/m2 or 2 mg/kg (up to 60 mg/day) orally once a day for at least 4 to 6 weeks; follow with alternate-day therapy: 40 mg/m2 or 1. Infrequent Relapsing Episodes: 1 relapse in 6 months or 1 to 3 relapses in 12 months : 60 mg/m2 or 2 mg/kg (up to 60 mg/day) orally once a day until urinary protein is negative for 3 days; follow with alternate-day therapy: 40 mg/m2 or 1. Frequent Relapsing Episodes: 2 relapses in 6 months or 4 or more relapses in 12 months: 60 mg/m2 or 2 mg/kg (up to 60 mg/day) orally once a day until complete remission for at least 3 days, then 40 mg/m2 or 1. Comments: -Studies have shown an initial steroid treatment period of 6 weeks followed by an alternate-day maintenance period of 6 weeks (total duration 12 weeks) has resulted in a lower rate of relapse. Use: Recommended for use in in children with steroid-sensitive nephrotic syndrome by the KDIGO (Kidney Disease: Improving Global Outcome) glomerulonephritis work group. Usual Pediatric Dose for Asthma – Acute, huge muscle without steroids. Age: Less than 12 years: Short-course “burst” therapy: 1 to 2 mg/kg orally in 2 divided doses until peak expiratory flow (PEF) is 70% of predicted or personal best -Dose of 1 mg/kg/day appears to be equally efficacious and may result in fewer behavioral side effects Maximum dose: 60 mg/day Duration of therapy: 3 to 10 days. Age: 12 years or older: Short-course “burst” therapy: 40 to 80 mg orally once a day or in 2 divided doses until PEF is 70% of predicted or personal best -For OUTPATIENT “burst” therapy: 40 to 60 mg orally once a day or in 2 divided doses Duration of therapy: 5 to 10 days. Comments: -The National Heart, Lung and Blood Institute (NHLBI) guidelines for the management of asthma recommend short courses of oral systemic corticosteroids to gain prompt control when initiating long-term therapy. Use: Recommended for treatment of acute episodes of asthma by the NHLBI National Heart, Lung and Blood Institute. Usual Pediatric Dose for Asthma – Maintenance. Less than 12 years old: 0. Comments: -Titrate dose to the lowest dose needed for control -Long-term use of oral systemic corticosteroids should be reserved for the most severe, difficult to control cases due to well documented risk for side effects. Use: Recommended for long-term treatment of severe persistent asthma by the NHLBI National Heart, Lung and Blood Institute. Use with caution; patients with cirrhosis may experience enhanced corticosteroids effects due to decreased metabolism and thereby may require lower doses. Elderly: Dose selection should be cautious generally starting at the low end of the dose range. Drug Discontinuation: -Abrupt discontinuation after high-dose or long-term therapy should be avoided. Recommendations: -To reduce the effect of drug-induced adrenocortical insufficiency, gradual dose reduction is recommended. Alternate Day Therapy: -Alternate day therapy may be considered for long term oral glucocorticoid therapy to help minimize adrenal suppression, and other glucocorticoid-related side effects. Dose adjustments of antidiabetic agents may be necessary as corticosteroids may increase blood glucose concentrations.
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