Starting systemic corticosteroid treatment

Recommendations

For adults, start systemic corticosteroids within 1 hour of presentation (unless contraindicated), regardless of severity at initial assessment.

Give starting dose of prednisolone 37.5–50 mg, then repeat each morning on second and subsequent days (total 5–10 days).

It is usually not necessary to taper the dose unless the duration of treatment exceeds 2 weeks.

Note: Pregnancy is not a contraindication for systemic corticosteroids. Oral prednisone or prednisolone is rated Category A for pregnancy.

mHow this recommendation was developed

For children aged 6 years and over (and children aged 0–5 if acute wheezing is severe), start systemic corticosteroids within 1 hour of presentation (unless contraindicated).

Give prednisolone as a single starting dose of 2 mg/kg (maximum 50 mg) orally, then 1 mg/kg each morning for 2 days (total 3 days). A longer course (e.g. 5 days) may be needed for severe cases.

It is usually not necessary to taper the dose unless the duration of treatment exceeds 2 weeks.

[ ] fFor children aged 0–5 years, systemic corticosteroids should generally be limited to those with severe acute wheezing to avoid over-use (particularly for those with intermittent viral-induced wheezing).

rHow this recommendation was developed

For adults, if corticosteroids cannot be given orally, give intravenously.

Give up to 100 mg hydrocortisone IV every 6 hours.

mHow this recommendation was developed

For children, if corticosteroids cannot be given orally, give intravenously.

Give either of the following:

[ ] hydrocortisone IV initial dose 8–10 mg/kg (maximum 300 mg), and then 4–5 mg/kg (maximum 300 mg) every 6 hours on day 1, every 12 hours on day 2, once daily on day 3 and, if needed, once daily on days 4–5
[ ] methylprednisolone IV initial dose 2 mg/kg (maximum 60 mg), and then 1 mg/kg (maximum 60 mg) every 6 hours on day 1, every 12 hours on day 2, once daily on day 3 and, if needed, once daily on days 4–5.

rHow this recommendation was developed