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Paper Chase 2: Single-Dose Oral Dexamethasone Versus Multidose Prednisolone

Nate Finnerty, MD and Rebekah Richards, MD
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A single dose of dexamethasone was NOT inferior to an oral steroid course.

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Mike W., MD -

Question from a listener:
I am wondering about the Paper Chase 2 - it was not discussed, but I am you know if the first dose of the Prednisolone was given in the ED. If the Decadron dose was given in the ED, and the Prednisolone was given as a prescription, it could have been seriously delayed, and that may have accounted for the "non-inferiority". I am not a big fan of Prednisolone, so I am all in for the single dose of Decadron, but was wondering about that detail. Once again...keep it up...
Answer from Nate Finnerty, MD (paper chaser):
Great question! A delay in prednisolone administration relative to decadron would have seriously confounded the results. Fortunately this was not the case and both interventions were initiated prior to ED discharge:

"After randomization and administration of the day 1 dose (day of enrollment), and before discharge from the
ED, the parents or legal guardians of patients randomized to the PRED group were instructed on how to appropriately
store the remaining study drug. Patients who vomited the medication in the ED within 30 minutes of administration
received a second dose.”

Kevin M., PA-C -

I have been using the one time dose of dexamethasone in my pediatric patients. I had a younger patient with a higher BMI and when doing the calculation I felt like the mg dosage was rather high. What is the max dose of dexamethasone that can be given?

Mike W., MD -

I typically max out at 10mg - the additional benefit of higher doses (if at all..) would be outweighed by the increased side effect profile

stacie o., 9692404 -

I have not had consistent results with the single dose dexamethasone with bounce back with persistent wheezing. I have had very good results with using a new formulation of oral prednisolone in an ODT, Orapred ODT if you can get insurance to cover. Parents with kids who have tried steroids previous have had very little problems giving the ODT tablet.

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