Why is Decadron (Dexamethasone) given to a 14-month-old patient?

From the Guidelines

Dexamethasone (Decadron) should be given to a 14-month-old patient with bacterial meningitis, specifically H. influenzae type b meningitis, at a dose of 0.15 mg/kg every 6 hours for 2-4 days, initiated 10-20 minutes prior to or concomitant with the first antimicrobial dose, as supported by the available evidence 1. The use of adjunctive dexamethasone in infants and children with H. influenzae type b meningitis is recommended due to its potential to improve patient outcomes by reducing inflammation and preventing long-term neurological sequelae.

• The dose and duration of dexamethasone therapy are crucial, with a recommended dose of 0.15 mg/kg every 6 hours for 2-4 days 1.
• It is essential to initiate dexamethasone therapy prior to or concomitant with the first antimicrobial dose to maximize its benefits 1.
• The decision to use adjunctive dexamethasone in pneumococcal meningitis is more controversial, and its use should be considered on a case-by-case basis, weighing the potential benefits and risks 1.
• As with any corticosteroid therapy, monitoring for potential side effects, such as irritability and increased appetite, is necessary, and the benefits of therapy should always outweigh the risks.

From the FDA Drug Label

DOSAGE REQUIREMENTS ARE VARIABLE AND MUST BE INDIVIDUALIZED ON THE BASIS OF THE DISEASE AND THE RESPONSE OF THE PATIENT. The FDA drug label does not answer the question.

From the Research

Decadron Administration in Children

• Decadron, also known as dexamethasone, is a corticosteroid used to treat various conditions, including asthma exacerbations in children 2, 3, 4, 5.
• The use of decadron in children is supported by several studies, which suggest that it is an effective and safe treatment option for acute asthma exacerbations 2, 4, 5.
• A study published in 2011 found that a single dose of dexamethasone was effective in treating mild-to-moderate asthma exacerbations in children, with similar outcomes to a 5-day course of prednisone or prednisolone 2.
• Another study published in 2014 found that dexamethasone was equivalent to prednisone or prednisolone in terms of efficacy and safety for acute asthma exacerbations in children 4.
• A 2021 study compared the outcomes of children hospitalized for acute asthma exacerbations who received dexamethasone versus prednisone/prednisolone, and found that those who received dexamethasone had a significantly shorter hospital length of stay 5.

Dosage and Administration

• The dosage and administration of decadron in children may vary depending on the specific condition being treated and the child's age and weight 3, 6.
• A study published in 2022 found that the use of multiple doses of dexamethasone in children hospitalized with croup was associated with a longer length of stay, but not with improved outcomes 6.
• The American Academy of Pediatrics recommends the use of dexamethasone for acute asthma exacerbations in children, with a typical dosage of 0.6 mg/kg per day, given orally or intramuscularly 4.

Safety and Efficacy

• Decadron is generally considered safe and effective for use in children, with a low risk of serious side effects 2, 4, 5.
• However, as with any medication, there is a risk of adverse effects, such as vomiting, and parents should be informed of these potential risks 4.
• The use of decadron in children should be carefully monitored, and parents should be instructed on how to administer the medication and what to expect in terms of side effects and efficacy 3, 6.