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In children with acute asthma exacerbations, is oral or injected dexamethasone as effective as predisone or prednisolone?
One or two doses of oral or intramuscular dexamethasone is as effective as 5 days of treatment with prednisone in children presenting to the emergency department with acute asthma. Neither oral product will win any awards for taste, but a single injection or oral dose of dexamethasone solution may be easier than trying to get 5 daily doses in. (LOE = 1a-)
Keeney GE, Gray MP, Morrison AK, et al. Dexamethasone for acute asthma exacerbations in children: A meta-analysis. Pediatrics 2014;133(3);493-499. [PMID:24515516]
Meta-analysis (randomized controlled trials)
These authors searched MEDLINE for randomized controlled trials comparing oral or intramuscular dexamethasone with prednisone or prednisolone in the treatment of acute asthma exacerbation in children. The weak strategy and the use of a single database makes me question the comprehensiveness of this search, though I couldn't find any unincluded studies by doing my own quick search. Studies were selected for inclusion independently by 2 authors and abstracted independently by 2 other authors. The quality of the 6 studies (N = 1129) was generally low (3 or 4 of a possible 8). Results were homogeneous and there was no evidence of publication bias. Three studies evaluated a single intramuscular dose of dexamethasone with oral prednis(ol)one, one compared a single oral dose with 5 days of prednis(ol)one, and 2 studies compared 2 daily doses of dexamethasone with 5 days of prednis(ol)one. Three was no difference between steroid groups with regard to relapse or hospitalization. Vomiting was less likely with dexamethasone.
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