Paediatric dosing errors with oral prednisolone mixture

The parents of an 18-month-old girl with croup called the Victorian Poisons Information Centre (VPIC) when they realised they had given their daughter three doses of prednisolone mixture during the day instead of one dose. She was also receiving amoxycillin syrup three times daily for an unknown indication.

The child had no symptoms of prednisolone toxicity. The parents were reassured that the child would be fine, although she might experience some mild gastrointestinal upset and be a bit irritable or difficult to settle.

Prednisolone is most commonly prescribed daily, and patients are advised to take it with or after food. If a label is written: ‘Give 3 mL daily after food for three days’, this could be interpreted as dosing three times a day.This may occur because there are three meals daily, or perhaps because prednisolone is often co-prescribed to children with an oral antibiotic that is given three times a day.

This dosing error does not usually lead to significant clinical consequences. Prednisolone toxicity is low for a single acute overdose or excessive dosing of short duration. However, adverse effects may occur and include gastrointestinal effects (nausea, vomiting, abdominal distension, increased appetite), insomnia, restlessness and increased motor activity.

To reduce dosing errors with prednisolone, we suggest that prescribers explain to parents that this mixture is only given once a day. We also suggest that pharmacists carefully consider the label instructions and reinforce them with verbal counselling. For example: ‘Give the child 3 mL once daily in the morning. The dose is best given after breakfast.’

Conflict of interest: none declared