Tools for Practice Outils pour la pratique


#162 Dexamethasone Versus Prednisone for Pediatric Asthma: Will the results take your breath away?


CLINICAL QUESTION
QUESTION CLINIQUE
 Are 1-2 doses of dexamethasone as effective as the standard five day prednisone regimen for treatment of pediatric asthma exacerbations?

BOTTOM LINE
RÉSULTAT FINAL
 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. For every ~20 children treated with dexamethasone, there will be one less vomited dose. 


CFPCLearn Logo

Reading Tools for Practice Article can earn you MainPro+ Credits

La lecture d'articles d'outils de pratique peut vous permettre de gagner des crédits MainPro+

 Join Now S’inscrire maintenant

Already a CFPCLearn Member? Log in

Déjà abonné à CMFCApprendre? Ouvrir une session


EVIDENCE
DONNÉES PROBANTES
  • Systematic review of six Randomized Controlled Trials (RCTs) of pediatric asthma exacerbations: 1-2 doses of oral/intramuscular dexamethasone versus daily oral prednisone x5 days.1 
    • No difference in relapse rates (visit to Emergency Department (ED), clinic, or hospitalization) at any time.   
    • Dexamethasone statistically significantly reduced vomiting in ED: 1.2% versus 5.3, Number Needed to Treat (NNT)=25.   
      • Also, NNT=26 vomiting at home. 
    • Limitations of systematic review: Study heterogeneity (dosages and routes of administration), most RCTs small, not blinded. 
    • Largest RCT in systematic review: 628 children aged 2-18 years with ED asthma exacerbation.2 Oral dexamethasone 0.6 mg/kg/day x2 days versus oral prednisone 2 mg/kg/day x5 days. 
      • No difference in relapse, symptom improvement or re-hospitalization at day 10. 
  • 2015 RCT not in systematic review: 245 children aged 2-17 years with ED asthma exacerbation.3 Single dose oral dexamethasone 0.3 mg/kg versus oral prednisolone 1 mg/kg/d x3 days.  
    • No difference: 
      • Primary outcome: Day four Pediatric Respiratory Assessment Measure: 0.91 versus 0.91. 
      • Hospital admission, length of admission, return to care, number of school or parental work days missed. 
    • Vomiting of first dose: 0% dexamethasone versus 5.7% prednisolone, NNT=18. 
Context: 
  • Systemic corticosteroids (versus placebo) for asthma exacerbations within one hour of ED presentation decreases hospital admissions (NNT=8).4  
  • In a palatability study, liquid dexamethasone scored 8.2 (out of 10, higher better) versus 5.0 for liquid prednisolone.5 
  • Two studies6,7 report that 79-88% of caregivers prefer 1-2 day over five day courses of steroids.  
  • Injectable dexamethasone solution may be given orally. Elixir (0.5 mg/ml) available by prescription.8,9 
  • The Canadian Pediatric Society lists both prednisone/prednisolone and dexamethasone as options for acute pediatric asthma exacerbations.10 

Latest Tools for Practice
Derniers outils pour la pratique
program image
Bradley LeDrew PharmD candidate

#363 Making a difference in indifference? Medications for apathy in dementia

In patients with dementia, how safe and effective are stimulants, antidepressants, and antipsychotics for treating apathy?
Read Lire 0.25 credits available Crédits disponibles
program image
Allison Paige MD CCFP

#362 Facing the Evidence in Acne, Part I: Oral contraceptives and spironolactone in females

How effective are combined oral contraceptives (COC) and spironolactone for treating acne of at least mild-moderate severity in females?
Read Lire 0.25 credits available Crédits disponibles
program image
Michael R Kolber MD CCFP MSc

#361 Preventing RSV Infections in Infants

How safe and effective are monoclonal antibodies to prevent respiratory syncytial virus (RSV) infections in infants?
Read Lire 0.25 credits available Crédits disponibles
May 9, 2016

This content is certified for MainPro+ Credits, log in to access

Ce contenu est certifié pour les crédits MainPro+, Ouvrir une session
Author(s)
Auteur(s)
  • Cathy Dewaal BScPharm
  • Christina Korownyk MD CCFP

1. Keeney GE, Gray MP, Morrison AK, et al. Pediatrics. 2014; 133(3):493-9.

2. Qureshi F, Zaritsky A, Poirier MP. J Pediatr. 2001; 139(1):20-6.

3. Cronin JJ, McCoy S, Kennedy U, et al. Ann Emerg Med. October 2015. pii: S0196-0644(15)01154-3. [Epub ahead of print]

4. Rowe BH, Spooner C, Ducharme FM, et al. Cochrane Database Syst Rev. 2001; (1):CD002178.

5. Hames H, Seabrook JA, Matsui D, et al. Can J Clin Pharmacol. 2008; 15(1):95-8.

6. Williams KW, Andrews AL, Heine D, et al. Clin Pediatr (Phila). 2013; 52(1):30-4.

7. Szlam S, Arnold DH. Clin Pediatr (Phila). 2015 Jan; 54(1):15-8.

8. CPS [Internet]. Ottawa (ON): Canadian Pharmacists Association; c2015 [updated 2011 Oct; cited 2016 Jan 23]. Corticosteroids; Systemic [CPhA monograph]. Available at: http://www.e-therapeutics.ca. Also available in paper copy from the publisher.

9. Can kids be given injectable dexamethasone orally? Available at: http://www.medscape.com/viewarticle/758927. Last accessed February 8, 2016.

10. Ortiz-Alvarez O, Mikrogianakis A; Canadian Paediatric Society, Acute Care Committee. Paediatr Child Health. 2012 May; 17(5):251-62.

Authors do not have any conflicts to disclose.