Information for Trainee: Scenario 1164

This systematic review and meta-analysis aimed to compare the clinical efficacy and safety of oral dexamethasone versus oral prednisone for treating acute asthma exacerbations in pediatric patients. Specifically, the authors sought to determine if dexamethasone, which is often administered over a shorter duration, offers advantages in reducing relapse rates, hospital readmissions, and adverse effects like vomiting compared to the traditional 3–5 day course of prednisone.

The researchers conducted a comprehensive search of major medical databases (PubMed, Embase, Scopus, CENTRAL, and Google Scholar) up to August 2019. They included six randomized controlled trials (RCTs) and one quasi-RCT involving children under 18 years old. The studies varied in their dosing regimens, with dexamethasone administered for 1 or 2 days and prednisone for 3 to 5 days. The primary outcome was the relapse rate (defined as an unscheduled visit to the emergency department or clinic), while secondary outcomes included hospital readmission and the incidence of vomiting.

The analysis found no statistically significant difference in relapse rates between the two treatments, regardless of the follow-up period (1–5 days or 10–15 days) or the duration of dexamethasone therapy (1-day vs. 2-day). Similarly, hospital readmission rates were comparable between the two groups. However, a clear safety benefit was observed for dexamethasone: children treated with dexamethasone experienced significantly less vomiting, both in the emergency department and at home, compared to those treated with prednisone.

For clinicians, these findings suggest that oral dexamethasone is a viable, potentially more tolerable alternative to prednisone for pediatric asthma exacerbations. The lower incidence of vomiting is particularly relevant for pediatric care, as it may improve treatment adherence and reduce parental anxiety. However, the authors caution that the evidence base is limited by the small sample sizes of the included trials and the lack of standardized dosing protocols, meaning that larger, more homogenous studies are required to confirm these results definitively.