Hydrocortisone:

Anti-inflammatory or immunosuppressive: Note: Dosing range variable; individualize dose for disease state and patient response.

Infants and Children:

Oral: 2.5 to 10 mg/kg/day or 75 to 300 mg/m2/day divided every 6 to 8 hours (Kliegman 2007).

IM, IV:

Manufacturer’s labeling: Initial: 0.56 to 8 mg/kg/day or 20 to 240 mg/m2/day in 3 or 4 divided doses.

Alternate dosing: Limited data available: 1 to 5 mg/kg/day or 30 to 150 mg/m2/day divided every 12 to 24 hours (Kliegman 2007).

Adolescents: Oral, IM, IV, SubQ: 15 to 240 mg every 12 hours (Kliegman 2007).

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Septic shock, fluid and catecholamine-refractory with suspected/proven adrenal insufficiency: Limited data available: Infants, Children, and Adolescents: IV: 50 to 100 mg/m2/day. Note: The maximum adult daily dose is 200 mg/day (~100 mg/m2/day) (ACCM/SCCM [Davis 2017]; Marx 2014; SCCM [Dellinger 2013]; Shulman 2007). In some cases, doses may be titrated up to 50 mg/kg/day as a continuous IV infusion, if necessary, for shock reversal in the short term; however, efficacy data variable with the higher doses (Brierley 2009; SCCM [Dellinger 2013]).