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Hot off the press! Pediatrics March 2014 just published results of a meta-analysis that compared 1 or 2 dose regimens of Dexamethasone versus 5 day course of Prednisone/Prednisolone for management of acute asthma exacerbations in pediatric patients. The results showed that Dexamethasone was as efficacious as the longer course of Prednisone. End points used were return trips to the emergency department and hospital admissions. On further review of the literature, parents tend to prefer the shorter duration of therapy with Dexamethasone. Also, there is less vomiting associated with Dexamethasone. There have been several articles published that show Dexamethasone is more cost-effective than Prednisone. Bottom line: consider giving single dose of Dexamethasone in the ER and then sending patient home with 1 additional dose.
References
Keeney G, Gray M, Morrison A, et al. Dexamethasone for Acute Asthma Exacerbations in Children: A Meta-analysis, Pediatrics March 2014, pp 493-499.
Williams K, Andrews A, Heine D, et al. Parental Preference for Short versus Long Course Corticosteroid Therapy in Children With Asthma Presenting to the Pediatric Emergency Department, Clinical Pediatrics January 2012, pp 30-34.
Andrews A, Wong K, Heine D, et al. A Cost-effectiveness Analysis of Dexamethasone versus Prednisone in Pediatric Acute Asthma Exacerbations, Annals of Emergency Medicine July 2012, pp 943-949