India · Paediatric mg/kg & Adult · Asthma · Nephrotic Syndrome · Croup · COPD · Autoimmune · Wysolone
* Taper rates are guides only. Adjust based on disease control and HPA axis recovery. Stop taper if disease flares.
| Indication | Paediatric dose | Adult dose | Duration | Taper? |
|---|---|---|---|---|
| Acute asthma | 1–2 mg/kg/day OD (max 40mg) | 30–40 mg OD | 3–5 days | No (short course) |
| Nephrotic — 1st episode | 2 mg/kg/day OD (max 60mg) → 1.5 mg/kg alternate days | — | 12 weeks total | Yes — KDIGO protocol |
| Croup | 0.6 mg/kg single dose (max 16mg) | — | Single dose | No |
| Severe allergy | 1 mg/kg/day (max 40mg) | 30–40 mg OD | 3–5 days | No |
| COPD exacerbation | — | 30–40 mg OD | 5 days | No (5-day course) |
| RA / inflammatory | — | 7.5–15 mg OD (bridge) | Weeks–months | Yes — slow |
| IBD flare | — | 40 mg OD tapering | 8 weeks taper | Yes — over 8 weeks |
| Polymyalgia / GCA | — | 15–60 mg OD | Months–years | Yes — very slow |
| ITP | 4 mg/kg/day (max 60mg) | 1 mg/kg/day OD | 4 weeks | Yes |
Prednisolone is a synthetic glucocorticoid and the most widely used oral corticosteroid in Indian clinical practice. It is available as Wysolone and Omnacortil in multiple tablet strengths and oral liquid, making it suitable for precise weight-based dosing in children as well as standard adult dosing. Prednisolone has approximately 4 times the glucocorticoid potency of hydrocortisone and minimal mineralocorticoid activity, making it preferred for most anti-inflammatory and immunosuppressive indications over hydrocortisone.
In Indian paediatric practice, prednisolone is most commonly prescribed for three conditions that together account for the majority of its use: acute asthma exacerbations, childhood nephrotic syndrome, and croup. In adult medicine, its most frequent indications include COPD exacerbations, rheumatological flares (RA, lupus, vasculitis), and inflammatory bowel disease. Correct dosing and appropriate tapering are critical — both under-dosing (leading to treatment failure) and over-dosing (causing unnecessary steroid side effects) are common errors.
Acute asthma: 1–2 mg/kg/day as a single morning dose, maximum 40 mg/day, for 3–5 days. The higher end (2 mg/kg) is used for severe exacerbations and in children under 2 years who mount a less predictable inflammatory response. No tapering is needed for courses of 5 days or less — the drug can be stopped abruptly. This follows BTS/SIGN and GINA 2024 guidelines.
Childhood nephrotic syndrome (first episode): The KDIGO 2021 and IAP-recommended regimen is prednisolone 2 mg/kg/day (maximum 60 mg) as a single daily morning dose for 4–6 weeks (induction), followed by 1.5 mg/kg on alternate days for 4–6 weeks (consolidation), then gradual tapering over the subsequent 4–6 months. This extended course is essential to reduce relapse rates — inadequate duration of initial steroid therapy is a major cause of frequent relapses in Indian children with nephrotic syndrome. Urine protein should be checked weekly during induction.
Croup (laryngotracheobronchitis): A single dose of prednisolone 0.6 mg/kg (maximum 16 mg) is highly effective at reducing stridor and reducing emergency department returns in children with moderate croup. The effect lasts 12–24 hours. For severe croup or those with respiratory distress, nebulised budesonide or IM dexamethasone may be preferred for faster onset.
ITP in children: Immune thrombocytopenic purpura — prednisolone 4 mg/kg/day (maximum 60 mg) for 4 weeks is a standard induction regimen when platelet count is critically low or there is significant bleeding. Taper over 2–4 weeks after the induction phase.
COPD exacerbation: Prednisolone 30–40 mg once daily for 5 days is the standard GOLD and NICE guideline recommendation for COPD exacerbations requiring hospital admission or significant clinical worsening. No tapering is required after a 5-day course — abrupt discontinuation is safe. A 5-day course is equivalent to a 14-day course in clinical outcomes while reducing cumulative steroid exposure.
Rheumatoid arthritis / inflammatory flare: Low-dose prednisolone 5–10 mg daily as a "bridge" until disease-modifying drugs take effect, or 15–20 mg for active flares. Long-term use at even low doses requires osteoporosis prophylaxis with calcium, vitamin D, and bisphosphonate in high-risk patients.
IBD flare: Prednisolone 40 mg/day for the first 1–2 weeks, then taper by 5 mg/week over 8 weeks total. If the patient is not in remission by 8 weeks, specialist review is needed. Steroid-dependent or steroid-refractory IBD requires immunomodulator or biologic therapy.
The need to taper depends on the duration and dose of therapy. Short courses (< 7 days at any dose, or < 3 weeks at doses below 40 mg/day) can be stopped abruptly — HPA axis suppression is reversible within days. For longer courses: once below 20 mg/day, reduce by 2.5–5 mg every 1–2 weeks. Below 10 mg/day, reduce more cautiously — by 1–2.5 mg every 2–4 weeks. Physiological replacement is 5–7.5 mg/day; once at this level, some patients need prolonged weaning over months. Sick-day rules apply during taper — if the patient develops fever or intercurrent illness, double the prednisolone dose temporarily and seek medical advice.
Before starting prednisolone for > 4 weeks (especially at doses > 15 mg/day), screen for latent tuberculosis (Mantoux / IGRA + chest X-ray) in all Indian patients — India has one of the world's highest TB burdens and immunosuppression from steroids can reactivate latent infection. Consider co-trimoxazole prophylaxis against Pneumocystis if prednisolone > 20 mg/day for > 4 weeks. Monitor random blood glucose in all patients regardless of prior diabetes history.