The primary outcome, measured only for patients discharged from the ED, was change in asthma score from ED presentation to 4-day follow-up examination, as assessed by a physician masked to group assignment. Each has it’s own limitations (as so many studies do). Unfortunately, the doses and routes of administration were not the same across all trials, though 0.6 mg/kg IM dexamethasone was … Required fields are marked There were 226 children included in this study, with more boys than girls. 12. 2 Systemic corticosteroids are the standard of care to treat acute asthma exacerbations. You prepare to discharge her on a three-day course of prednisolone (PRED). Her parents ask if there is something else that tastes better because it is a real struggle to get her to take the medicine. After receiving three treatments with albuterol and Atrovent, she is doing much better. The Pediatric Respiratory Assessment Measure (PRAM)“In children with acute exacerbations of asthma, a single dose of oral dexamethasone (0.3 mg/kg) is noninferior to a 3-day course of oral prednisolone (1 mg/kg per day) as measured by the mean PRAM score on day 4.”There were 226 children included in this study, with more boys than girls. Levine went on to review the pediatric literature—many small studies and a few larger randomized trials—to conclude that a single dose of dexamethasone was probably as good as a course of prednisone for kids in the ED with asthma exacerbations. Some exacerbations warrant admission for inpatient care, but many can be managed effectively on an outpatient basis with a combination of avoiding environmental triggers, inhaled β-agonists, a short course of oral steroids, and close follow-up.Traditionally, a short course of steroids (prednisone or prednisolone for 5 days) has been recommended.Two pediatric studies have compared the use of 2 doses of oral dexamethasone (day 1 and day 2) with 5 days of prednisone (or prednisolone). Dexamethasone for acute … Intramuscular dexamethasone injections are painful and can be difficult to administer, so oral administration is a preferred route, especially owing to a suggested 80% bioavailability. Single-dose regimens are of greatest interest to health care providers in ambulatory care settings because of the potential to improve compliance, as has been documented in studies of a variety of other single-dose therapies.Three studies reported the use of a single dose of intramuscular (IM) dexamethasone. 2016;67(5):593-601.e3. In children with acute asthma, 2 doses of dexamethasone provide similar efficacy with improved compliance and fewer side effects than 5 doses of prednisone. PRED is also associated with a significant amount of vomiting; this is one of the leading reasons for treatment failure for outpatient asthma.In children presenting to the emergency department with an acute exacerbation of asthma, is a single oral dose of DEX noninferior to three days of PRED?Cronin JJ, McCoy S, Kennedy U, et al. He is on the Best Evidence in Emergency Medicine faculty and is creator of the knowledge translation project the The IV formation of dexamethasone, which is commonly used po, is slightly less absorbed from the gi tract, so I would lean towards giving the higher dose seen in other studies of 0.6mg/kg to a max of 16mg, which is also a protocol used at many US children’s hospitals.Your email address will not be published. A randomized trial of single-dose oral dexamethasone versus multidose prednisolone for acute exacerbations of asthma in children who attend the emergency department. Evidence: • Systematic review of six Randomized Controlled Trials (RCTs) of pediatric asthma …

from the ED (Saunders 1987, Thomas 1996), and given the acceptance of single-dose dexamethasone for asthma exacerbation in children, further evaluation of alternative, shortened dosing regimens in adults seems warranted. A randomized trial of single-dose oral dexamethasone versus multidose prednisolone for acute exacerbations of asthma in children who attend the emergency department. The intensity of the disease varies with time and … Applies to the following strengths: 0.25 mg; 0.5 mg; 0.75 mg; 1.5 mg; 4 mg; 6 mg; 0.5 mg/5 mL; 4 mg/mL; 8 mg/mL; 24 mg/mL; 10 mg/mL; 1 mg/mL; 1 mg; 2 mg; 16 mg/mL; sodium phosphate; acetate; 0.1 mg/inh; 10 mg/mL preservative-freeInitial dose: 10 mg IV once, followed by 4 mg IM every 6 hours until maximal response is noted40 mg oral/IV on days 1, 8, 15, 22, and repeated every 4 weeksAcute exacerbation: 30 mg orally once a day for 1 week followed by 4 to 8 mg orally every other day for 1 monthDosing should be individualized on the basis of disease and patient responseDosing should be individualized on the basis of disease and patient responseDosing should be individualized on the basis of disease and patient responseDosing should be individualized on the basis of disease and patient response0.6 mg/kg/day oral/IV for 4 days every 4 weeks for 6 cyclesElderly: The more serious consequences of common side effects should be carefully considered when initiating therapy.Consult WARNINGS section for additional precautions.Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. © 2020.

Overall hospital admission rates at 5 days were 9 of 56 for dexamethasone and 10 of 54 for prednisolone (The compliance rates following emergency department visits for both general pediatric prescriptionsMost of the single-dose dexamethasone studies point out its compliance advantage over multiple days of prednisone. Comparative efficacy of oral dexamethasone versus oral prednisone in acute pediatric asthma. Bottom-line: Treatment of pediatric asthma exacerbations with short-course dexamethasone (0.6 mg/kg x 1-2 doses) is a safe and effective alternative to traditional five day courses of prednisone. Asthma is a common pediatric disease that results in significant limitation of activity and an estimated loss of 14.4 million school days in children (1).