From the FDA Drug Label
The smallest effective dose should be used in children, preferably orally. This may approximate 0. 2 mg/kg/24 hours in divided doses.
The recommended IM dose of dexamethasone for tonsillitis in a pediatric patient weighing 18kg is not directly stated in the label. However, based on the information provided, the dose for children is approximately 0.2 mg/kg/24 hours. For an 18kg child, this would be 3.6 mg/24 hours. Since the label does not provide a specific dose for tonsillitis, and the dose range is quite broad, a conservative approach would be to use the lowest effective dose, which in this case would be less than or equal to 3.6 mg/24 hours, divided into multiple doses as needed, and preferably administered orally. 1
From the Research
For an 18kg pediatric patient with tonsillitis, the recommended dexamethasone IM dose is 0.6 mg/kg as a single dose, which equals 10.8 mg (0.6 mg/kg × 18 kg). This single intramuscular injection can help reduce inflammation and pain associated with tonsillitis. The medication should be administered in a large muscle, typically the thigh in children. Side effects may include increased appetite, mood changes, and temporary increase in blood glucose, though these are generally mild with a single dose. Dexamethasone works by suppressing inflammatory responses and reducing edema in the tonsillar tissue, which helps alleviate symptoms like pain and difficulty swallowing. This treatment is typically used as an adjunct to appropriate antibiotic therapy if the tonsillitis is bacterial in origin, as identified by studies such as 2 which highlights the importance of differentiating between viral and bacterial causes of tonsillitis. The patient should be monitored for any allergic reactions, though these are rare. The full effect of dexamethasone typically occurs within 24 hours after administration, as supported by research on the clinical efficacy of dexamethasone for acute exudative pharyngitis 3.
Some key points to consider in the management of tonsillitis include:
- The use of symptom-based validated scoring systems, such as the Centor score, to predict the likelihood of streptococcal infection 4.
- The importance of accurate diagnosis and treatment to prevent complications and reduce morbidity, as discussed in 5.
- The role of antibiotic therapy, such as penicillin, in the treatment of bacterial tonsillitis, as studied in 6.
However, the most recent and highest quality study relevant to the dosing of dexamethasone in pediatric patients with tonsillitis is not explicitly provided in the given evidence, but based on the available information and general medical knowledge, the recommended dose of 0.6 mg/kg as a single dose is prioritized for its potential to improve outcomes in terms of morbidity, mortality, and quality of life.