What is the oral dose of Decadron (dexamethasone) for pediatric patients?

Dexamethasone Oral Dosing for Pediatric Patients

Standard Dosing by Indication

For most pediatric conditions requiring dexamethasone, the dose is 0.15 mg/kg orally every 6 hours for 2-4 days, which is the evidence-based standard for bacterial meningitis and cerebellitis. 1, 2

Specific Clinical Scenarios

Bacterial Meningitis (H. influenzae type b)

• Dose: 0.15 mg/kg orally or IV every 6 hours for 2-4 days 1
• Timing: Must be initiated 10-20 minutes prior to, or at least concomitant with, the first antimicrobial dose 1
• Critical caveat: Do NOT give dexamethasone if antimicrobial therapy has already been started, as it will not improve outcomes 1

Cerebellitis

• Dose: 0.15 mg/kg orally every 6 hours for 2-4 days 2
• Duration: 2-4 days is typically sufficient for mild to moderate cases, with clinical resolution within approximately one week 2
• No tapering required: A single short course does not cause clinically significant adrenal suppression 2

Croup

• Dose: 0.15 mg/kg as a single oral dose (range 0.15-0.6 mg/kg) 3, 4
• Evidence: 0.15 mg/kg is as effective as higher doses (0.3 or 0.6 mg/kg) in relieving symptoms and reducing hospitalization duration 4

Acute Asthma Exacerbations

• Dose: 0.3 mg/kg as a single oral dose 5, 6
• Alternative: This single dose is noninferior to prednisolone 1 mg/kg/day for 3 days 6
• Advantage: No vomiting of medication (0% vs 11.5% with prednisolone) and improved compliance 6

Dosing Considerations by Age and Weight

Obesity Adjustment

• Use total body weight for dosing calculations 7
• Weight-based dosing of 0.5-1 mg/kg in children with obesity achieves comparable exposures to adults 7

Neonates and Preterm Infants

• Avoid high-dose dexamethasone (≥0.5 mg/kg/day) in extremely low birth weight infants due to risk of gastrointestinal perforation, hypertension, hyperglycemia, and impaired growth 1, 8
• If corticosteroids are needed for bronchopulmonary dysplasia, consider low-dose hydrocortisone (1 mg/kg/day) instead 1

Important Safety Considerations

Adverse Effects with High-Dose or Prolonged Use

• Sleeplessness, behavioral changes, hypertension, anxiety, gastric distress 2
• Gastrointestinal perforation (13% vs 4% with placebo in neonates receiving 0.15 mg/kg/day) 8
• Decreased growth and head circumference in preterm infants 8
• Neurodevelopmental impairment with high doses (≥0.5 mg/kg/day) in neonates 1

When NOT to Use Dexamethasone

• Streptococcal pharyngitis: Not recommended by IDSA guidelines; use acetaminophen or NSAIDs for symptom management instead 9
• After antibiotics started: In bacterial meningitis, dexamethasone is ineffective if given after antimicrobial therapy has begun 1

Practical Dosing Algorithm

1. Identify the indication (meningitis, cerebellitis, croup, or asthma)
2. Calculate dose based on total body weight:
   • Meningitis/cerebellitis: 0.15 mg/kg every 6 hours for 2-4 days
   • Croup: 0.15 mg/kg single dose
   • Asthma: 0.3 mg/kg single dose
3. Timing matters: For meningitis, give 10-20 minutes before or with first antibiotic dose 1
4. No tapering needed for short courses (2-4 days) 2
5. Monitor for: Hypertension, hyperglycemia, behavioral changes, and gastrointestinal symptoms 2, 8