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Emergent intramuscular dosing can be given if child is not tolerating oral medications or unable to get IV within 15 minutes. IM hydrocortisone sodium succinate doses are: [3] 25 mg for child 3 years and younger; 50 mg for children >3 yrs – 12 years; 100 mg for children 12 years and older.
To prevent steroid-induced osteoporosis, the steroid dose and duration should be as low and as short as possible. All patients on long term glucocorticoids (≥3 months) should be encouraged to do weightbearing exercise, avoid smoking and excess alcohol and take fall prevention measures. Daily calcium and vitamin d intake should be sufficient.
Methylprednisolone dose and duration have been implicated in PAE development. 20 mg/day of prednisone (16 mg/day of methylprednisolone) is the threshold dosage for PAE development agreed upon by many studies. [24]
Prednisone is a synthetic pregnane corticosteroid and derivative of cortisone and is also known as δ 1-cortisone or 1,2-dehydrocortisone or as 17α,21-dihydroxypregna-1,4-diene-3,11,20-trione. [ 42 ] [ 43 ]
In general, use a potent preparation short term and weaker preparation for maintenance between flare-ups. While there is no proven best benefit-to-risk ratio, [11] if prolonged use of a topical steroid on a skin surface is required, a pulse therapy should be undertaken.
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Prednisolone has a relatively short half-life, ranging 2–4 hours. It also has a large therapeutic window, considering the dosage required to produce a therapeutic effect is a few times higher than what the body naturally produces. [14] Prednisolone is 70–90% plasma protein bound, it binds to proteins such as albumin. [14]
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