Introduction Prednisolone is an established treatment for viral induced wheeze and asthma exacerbations in children. However, it requires a multiple dose regime, is relatively unpalatable and causes vomiting. In our centre, along with much of the UK, a generic branded prednisolone tablet is now in use which appears to be even more unpalaTable. Despite attempts to improve tolerability, a retrospective notes review in our department in September 2015 revealed that 28% of children (14/50) did not tolerate prednisolone. This has led to increased concerns about compliance with treatment after discharge. Dexamethasone is suggested as an alternative due to its longer half-life and therefore shorter course, better tolerability and reduced vomiting.
Aims and methods We aimed to establish whether dexamethasone is equivalent to prednisolone in the treatment of wheeze in children. To do this we performed a review of the literature using MEDLINE and Google Scholar to ask the question: In children of all ages, is dexamethasone as effective as prednisolone in treating wheeze?
Results We found 11 papers comparing dexamethasone to prednisolone of which 8 were controlled trials, one was a retrospective cohort study and two were meta-analyses. There was significant heterogeneity of dosage and method of administration of dexamethasone, including intramuscular, nebulised and oral routes. We analysed four controlled studies of oral dexamethasone, as this was our preferred route. Details of the four studies can be found in Table 1. All of the studies found that dexamethasone was non-inferior to prednisolone. One study compared a single 0.6mg/kg dose of dexamethasone with 5 days of prednisolone, two studies compared two daily 0.6mg/kg doses of dexamethasone with 5 days of prednisolone and the most recent study compared a single 0.3mg/kg dose of dexamethasone with 3 days of prednisolone. Most of the studies have some limitations which may affect the validity of the results.
Conclusion Dexamethasone is non-inferior to prednisolone in the treatment of wheeze in children and has better tolerability and compliance. However, the optimal dose and duration remain unclear. Clinicians can consider using dexamethasone in children with acute wheeze, particularly those who do not tolerate Prednisolone.
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