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Corticosteroid Use in Management of Pediatric Emergency Conditions

Corticosteroids - Pharyngitis - Bacterial Meningitis - Asthma Exacerbation - Cover

Corticosteroids Use in Management of Pediatric Emergency Conditions

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  About This Issue

Although corticosteroids have been used for over half a century, their use for management of many pediatric conditions is controversial. In this issue, you will learn:

•   The mechanisms of corticosteroid effects
•   Which corticosteroids are used to treat pediatric conditions, their associated properties, and recommended pediatric dosing
•   Evidence-based recommendations for whether or not to use corticosteroids in the management of pediatric patients with an asthma exacerbation, croup, acute pharyngitis, anaphylaxis, acute spinal injury, or bacterial meningitis
•   Preferred routes, dosages, and corticosteroids, as well as alternate choices
•   Which adverse effects have been shown to be associated with corticosteroid use

  Issue Info

Authors: Asalim Thabet, MD; Tyler Greenfield, DO; Richard M. Cantor, MD, FAAP, FACEP

Peer Reviewers: Augusta Saulys, MD, FAAP, FACEP; Catherine Sellinger, MD

Publication Date: March 1, 2018

CME Expiration Date: March 1, 2021

CME Credits: 4 AMA PRA Category 1 CreditsTM, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2A or 2B Credits.  Included as part of the 4 credits, this CME activity is eligible for 4 Pharmacology CME credits.

PubMed ID: 29490126

  Issue Features
  Table of Contents
  1. Abstract
  2. Case Presentations
  3. Introduction
  4. Critical Appraisal of the Literature
  5. Mechanisms of Corticosteroid Effects
  6. Prehospital Care
  7. Corticosteroids for the Management of Pediatric Conditions
    1. Asthma
      1. Management of Asthma
      2. Summary
    2. Croup
      1. Management of Croup
      2. Summary
    3. Acute Pharyngitis
      1. Management of Acute Pharyngitis in Children
      2. Summary
    4. Anaphylaxis
      1. Management of Anaphylaxis
      2. Summary
    5. Acute Spinal Cord Injury
      1. Management of Acute Spinal Cord Injury
      2. Summary
    6. Bacterial Meningitis
      1. Management of Bacterial Meningitis
      2. Summary
  8. Adverse Effects
    1. No Adverse Effects
    2. Cerebral Thrombosis
    3. Gastrointestinal Bleeding
    4. Growth Restriction
    5. Bacterial Tracheitis
    6. Behavioral Changes
  9. Controversies
  10. Special Populations
  11. Summary
  12. Risk Management Pitfalls for Using Corticosteroids to Manage Pediatric Conditions
  13. Time- and Cost-Effective Strategies
  14. Case Conclusions
  15. Tables
    1. Table 1. Types of Corticosteroids Used to Treat Pediatric Conditions, Their Associated Properties, and Recommended Pediatric Dosing
    2. Table 2. Comparison of Studies Evaluating the Use of Corticosteroids for Management of Acute Pharyngitis
    3. Table 3. Comparison of Studies Evaluating the Use of Corticosteroids for Management of Bacterial Meningitis
  16. References
 
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Abstract

Corticosteroids have been used for over half a century to treat various inflammatory disorders; however, their use in many pediatric conditions remains controversial. This issue reviews evidence on corticosteroid treatment in acute asthma exacerbations, croup, acute pharyngitis, anaphylaxis, acute spinal injury, and bacterial meningitis. While corticosteroids are clearly indicated for management of asthma exacerbations and croup, they are not universally recommended for potential spinal cord injury. Due to insufficient data or conflicting data, corticosteroids may be considered in children with acute pharyngitis, anaphylaxis, and bacterial meningitis.

 

Case Presentations

An otherwise-healthy 3-year-old boy presents to the ED after awakening in the middle of the night with a barky cough, gasping for air. His mother denies other symptoms and states that foreign body aspiration is unlikely. Upon arrival to the ED via ambulance, the boy continues to have a barky cough and inspiratory stridor with agitation, but no stridor at rest. His physical examination is otherwise unremarkable and his airway is patent, without any evidence of compromise. What are the next steps in the management of this patient? Are corticosteroids indicated in this situation? If so, which one should you prescribe, and at what dosage?

A 13-year-old adolescent girl with a past history of recurrent tonsillitis presents because of progressively worsening pain, increasing dysphagia, decreased oral intake, muffled voice, and unremitting fevers, despite being on an appropriate oral antibiotic. The girl states the illness began with a sore throat, headache, fever, and abdominal pain 4 days ago. On physical examination, she has 4+ right tonsillar enlargement with exudate. Her rapid strep test is positive. A CT scan was ordered to rule out deep space infection, and it showed no sign of phlegmon or abscess. The girl's airway is patent. You begin to consider how you should manage this patient. You decide to consult ENT, and they recommend changing the antibiotic and administering a dose of corticosteroids. Do you agree that corticosteroids are warranted? If so, which corticosteroid should you prescribe, and at what dosage?

A 15-year-old adolescent boy presents with a stiff neck and worsening severe, persistent headaches; altered mental status; and fevers for a week. He has been previously healthy, but is unimmunized. He has no nausea or vomiting, and no vision or hearing concerns. His physical examination is positive for meningismus, Kernig and Brudzinski signs, and altered mentation. Although the patient is altered, he is able to control his own airway. Lumbar puncture analysis is suggestive of bacterial meningitis. Should you consider a dose of corticosteroids? If so, which one should you prescribe, and at what dosage?

 

Introduction

The corticosteroid class of drugs provides some of the most important synthetic glucocorticoids, and have been used in many types of treatment since the 1950s.1 Despite the half-century of corticosteroid usage, there is still much debate about their use in many pediatric diseases. This issue of Pediatric Emergency Medicine Practice reviews the mechanisms of corticosteroids and the evidence-based role of corticosteroid treatment in a variety of pediatric conditions.

 

Critical Appraisal of the Literature

A review of the literature was conducted using PubMed and the Cochrane Database of Systematic Reviews. The search was performed using the terms asthma, wheezing, croup, pharyngitis, acute spinal injury, anaphylaxis, allergic reaction, meningitis, corticosteroids, dexamethasone, prednisone, prednisolone, fluticasone, hydrocortisone, budesonide, cerebral thrombosis, gastrointestinal bleed, bacterial tracheitis, and growth restriction. Over 150 articles were reviewed, 93 of which were chosen for inclusion, including a number of case reports, clinical reviews, and retrospective and prospective controlled studies.

 

Risk Management Pitfalls for Using Corticosteroids to Manage Pediatric Conditions

1. “My patient had only mild croup, so I did not treat him with corticosteroids. He came back the next day with worsening symptoms and stridor.”

Patients with mild croup can progress and develop stridor, in addition to hoarseness and a barky cough. Once the child has stridor, corticosteroids should be given. The adjuvant use of corticosteroids will allow the patient to have additional therapeutic coverage for up to 72 hours (if using dexamethasone) and will decrease the incidence of return visits, the need for further treatment, or admission.

5. “The patient had severe pharyngitis. I felt that corticosteroids were necessary for pain relief.”

The efficacy of corticosteroids for pharyngitis pain relief has not been demonstrated uniformly, and there is currently insufficient evidence to endorse routine use.

7. “I treat patients with suspected acute spinal cord injury with corticosteroids—regardless of the time from injury—because it provides significant symptomatic relief.”

Corticosteroid use for acute spinal cord injury is no longer recommended. The only evidence of benefit was found if corticosteroids were given in the first 8 hours after injury.

 

Tables

Table 2. Comparison of Studies Evaluating the Use of Corticosteroids for Management of Acute Pharyngitis

 

References

Evidence-based medicine requires a critical appraisal of the literature based upon study methodology and number of subjects. Not all references are equally robust. The findings of a large, prospective, randomized, and blinded trial should carry more weight than a case report.

To help the reader judge the strength of each reference, pertinent information about the study, such as the type of study and the number of patients in the study is included in bold type following the references, where available. The most informative references cited in this paper, as determined by the author, are noted by an asterisk (*) next to the number of the reference.

  1. de Benedictis FM, Canny GJ, Levison H. The role of corticosteroids in respiratory diseases of children. Pediatr Pulmonol. 1996;22(1):44-57. (Review article)
  2. Principi N, Bianchini S, Baggi E, et al. No evidence for the effectiveness of systemic corticosteroids in acute pharyngitis, community-acquired pneumonia and acute otitis media. Eur J Clin Microbiol Infect Dis. 2013;32(2):151-160. (Systematic review)
  3. de Benedictis FM, Bush A. Corticosteroids in respiratory diseases in children. Am J Respir Crit Care Med. 2012;185(1):12-23. (Systematic review)
  4. Lexicomp. Corticosteroids systemic equivalences. Available at: https://online.lexi.com/lco/action/home (requires log-in). Accessed February 15, 2018. (Clinical drug information)
  5. Sears M. Natural history and epidemiology. In: Fitzgerald JM, Ernst P, Boulet L-P, O’Byrne, PM, ed. Evidence-Based Asthma Management. Hamilton, Ontario, Canada: BC Decker Inc; 2000:1-12. (Textbook chapter)
  6. Jones BP, Paul A. Management of acute asthma in the pediatric patient: an evidence-based review. Pediatr Emerg Med Pract. 2013;10(5):1-23. (Review)
  7. * U.S. Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Asthma Education and Prevention Program. Expert panel report 3: guidelines for the diagnosis and management of asthma 2007; available at: https://www.nhlbi.nih.gov/files/docs/guidelines/asthgdln.pdf. Accessed February 15, 2018. (Guidelines)
  8. Qureshi F, Zaritsky A, Poirier MP. Comparative efficacy of oral dexamethasone versus oral prednisone in acute pediatric asthma. J Pediatr. 2001;139(1):20-26. (Prospective; 533 patients)
  9. Greenberg RA, Kerby G, Roosevelt GE. A comparison of oral dexamethasone with oral prednisone in pediatric asthma exacerbations treated in the emergency department. Clin Pediatr (Phila). 2008;47(8):817-823. (Prospective; 89 patients)
  10. Altamimi S, Robertson G, Jastaniah W, et al. Single-dose oral dexamethasone in the emergency management of children with exacerbations of mild to moderate asthma. Pediatr Emerg Care. 2006;22(12):786-793. (Prospective; 134 patients)
  11. Cross KP, Paul RI, Goldman RD. Single-dose dexamethasone for mild-to-moderate asthma exacerbations: effective, easy, and acceptable. Can Fam Physician. 2011;57(10):1134-1136. (Review)
  12. Topal E, Gucenmez OA, Harmanci K, et al. Potential predictors of relapse after treatment of&
  13. Schuh S, Reisman J, Alshehri M, et al. A comparison of inhaled fluticasone and oral prednisone for children with severe acute asthma. N Engl J Med. 2000;343(10):689-694. (Prospective; 100 patients)
  14. Schuh S, Dick PT, Stephens D, et al. High-dose inhaled fluticasone does not replace oral prednisolone in children with mild to moderate acute asthma. Pediatrics. 2006;118(2):644-650. (Prospective; 69 patients)
  15. Kairys SW, Olmstead EM, O’Connor GT. Steroid treatment of laryngotracheitis: a meta-analysis of the evidence from randomized trials. Pediatrics. 1989;83(5):683-693. (Meta-analysis; 10 reports, 1286 patients)
  16. Husby S, Agertoft L, Mortensen S, et al. Treatment of croup with nebulised steroid (budesonide): a double blind, placebo controlled study. Arch Dis Child. 1993;68(3):352-355. (Prospective; 36 patients)
  17. Klassen TP, Feldman ME, Watters LK, et al. Nebulized budesonide for children with mild-to-moderate croup. N Engl J Med. 1994;331(5):285-289. (Prospective; 54 patients)
  18. Griffin S, Ellis S, Fitzgerald-Barron A, et al. Nebulised steroid in the treatment of croup: a systematic review of randomised controlled trials. Br J Gen Pract. 2000;50(451):135-141. (Systematic review; 8 trials, 574 children)
  19. Bjornson CL, Klassen TP, Williamson J, et al. A randomized trial of a single dose of oral dexamethasone for mild croup. N Engl J Med. 2004;351(13):1306-1313. (Multicenter randomized double-blind placebo-controlled clinical trial; 720 patients)
  20. Geelhoed GC, Turner J, Macdonald WB. Efficacy of a small single dose of oral dexamethasone for outpatient croup: a double blind placebo controlled clinical trial. BMJ. 1996;313(7050):140-142. (Prospective; 100 patients)
  21. Johnson DW, Jacobson S, Edney PC, et al. A comparison of nebulized budesonide, intramuscular dexamethasone, and placebo for moderately severe croup. N Engl J Med. 1998;339(8):498-503. (Prospective double-blinded randomized trial; 144 patients)
  22. * Russell K, Weibe N, Saenz A, et al. Glucocorticoids for croup. Cochrane Database Syst Review. 2004;1: CD001955. (Systematic review; 31 studies, 3767 patients)
  23. Fifoot AA, Ting JY. Comparison between single-dose oral prednisolone and oral dexamethasone in the treatment of croup: a randomized, double-blinded clinical trial. Emerg Med Australas. 2007;19(1):51-58. (Prospective; 99 patients)
  24. Alshehr A, Almegamsi, T, Hammdi, A. Efficacy of a small dose of oral dexamethasone in croup. Biomedical Research. 2005;16(1):65-72. (Double-blind randomized trial; 72 children with acute laryngotracheobronchitis)
  25. Klassen TP, Craig WR, Moher D, et al. Nebulized budesonide and oral dexamethasone for treatment of croup: a randomized controlled trial. JAMA. 1998;279(20):1629-1632. (Prospective; 197 patients)
  26. Geelhoed GC, Macdonald WB. Oral and inhaled steroids in croup: a randomized, placebo-controlled trial. Pediatr Pulmonol. 1995;20(6):355-361. (Randomized placebo-controlled trial; 80 patients)
  27. Geelhoed GC. Budesonide offers no advantage when added to oral dexamethasone in the treatment of croup. Pediatr Emerg Care. 2005;21(6):359-362. (Prospective; 72 patients)
  28. Hahn EO, Houser HB, Rammelkamp CH Jr, et al. Effect of cortisone on acute streptococcal infections and poststreptococcal complications. J Clin Invest. 1951;30(3):274-281. (Prospective; 87 patients)
  29. Glaser RJ, Berry JW, Loeb LH, et al. Effect of ACTH and cortisone in experimental streptococcal and pneumococcal infections. J Lab Clin Med. 1950;36(5):826. (Bench research)
  30. Mygind N, Nielsen LP, Hoffmann HJ, et al. Mode of action of intranasal corticosteroids. J Allergy Clin Immunol. 2001;108(1 Suppl):S16-S25. (Commentary)
  31. O’Brien JF, Meade JL, Falk JL. Dexamethasone as adjuvant therapy for severe acute pharyngitis. Ann Emerg Med. 1993;22(2):212-215. (Prospective; 58 patients)
  32. Marvez-Valls EG, Ernst AA, Gray J, et al. The role of betamethasone in the treatment of acute exudative pharyngitis. Acad Emerg Med. 1998;5(6):567-572. (Randomized controlled trial; 92 patients)
  33. Wei JL, Kasperbauer JL, Weaver AL, et al. Efficacy of single-dose dexamethasone as adjuvant therapy for acute pharyngitis. Laryngoscope. 2002;112(1):87-93. (Double-blinded randomized controlled trial; 111 patients)
  34. Hayward GN, Hay AD, Moore MV, et al. Effect of oral dexamethasone without immediate antibiotics vs placebo on acute sore throat in adults: a randomized clinical trial. JAMA. 2017;317(15):1535-1543. (Randomized controlled trial; 565 patients)
  35. * Hayward G, Thompson MJ, Perera R, et al. Corticosteroids as standalone or add-on treatment for sore throat. Cochrane Database Syst Rev. 2012;10:CD008268. (Systematic review; 8 trials, 743 participants)
  36. Chiappini E, Bortone B, Di Mauro G, et al. Choosing wisely: the top-5 recommendations from the Italian Panel of the National Guidelines for the Management of Acute Pharyngitis in Children. Clin Ther. 2017;39(3):646-649. (Review)
  37. Bulloch B, Kabani A, Tenenbein M. Oral dexamethasone for the treatment of pain in children with acute pharyngitis: a randomized, double-blind, placebo-controlled trial. Ann Emerg Med. 2003;41(5):601-608. (Randomized controlled trial; 184 children)
  38. Roy M, Bailey B, Amre DK, et al. Dexamethasone for the treatment of sore throat in children with suspected infectious mononucleosis: a randomized, double-blind, placebo-controlled, clinical trial. Arch Pediatr Adolesc Med. 2004;158(3):250-254. (Randomized controlled trial; 40 patients)
  39. Olympia RP, Khine H, Avner JR. Effectiveness of oral dexamethasone in the treatment of moderate to severe pharyngitis in children. Arch Pediatr Adolesc Med. 2005;159(3):278-282. (Prospective randomized double-blind placebo-controlled clinical trial; 150 patients)
  40. Niland ML, Bonsu BK, Nuss KE, et al. A pilot study of 1 versus 3 days of dexamethasone as add-on therapy in children with streptococcal pharyngitis. Pediatr Infect Dis J. 2006;25(6):477-481. (Randomized double-blinded 3-arm study; 90 patients)
  41. Sadeghirad B, Siemieniuk RAC, Brignardello-Petersen R, et al. Corticosteroids for treatment of sore throat: systematic review and meta-analysis of randomised trials. BMJ. 2017;358:j3887. (Systematic review and meta-analysis; 10 trials, 1426 patients)
  42. Marvez-Valls EG, Stuckey A, Ernst AA. A randomized clinical trial of oral versus intramuscular delivery of steroids in acute exudative pharyngitis. Acad Emerg Med. 2002;9(1):9-14. (Randomized controlled trial; 78 patients)
  43. Mullarkey C. Soothing a sore throat: the efficacy and safety of steroids in acute pharyngitis. Ir J Med Sci. 2011;180(4):837-840. (Systematic review; 5 randomized controlled trials and 1 systematic review)
  44. Lee S, Sadosty AT, Campbell RL. Update on biphasic anaphylaxis. Curr Opin Allergy Clin Immunol. 2016;16(4):346-351. (Review)
  45. Grunau BE, Wiens MO, Rowe BH, et al. Emergency department corticosteroid use for allergy or anaphylaxis is not associated with decreased relapses. Ann Emerg Med. 2015;66(4):381-389. (Retrospective; 2701 patients)
  46. Sampson HA, Munoz-Furlong A, Campbell RL, et al. Second symposium on the definition and management of anaphylaxis: summary report--Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. J Allergy Clin Immunol. 2006;117(2):391-397. (Symposium)
  47. Kim SH, Kim HY. Anaphylaxis induced by oral methylprednisolone in a 10-year-old boy. Pediatr Int. 2014;56(5):783-784. (Case report)
  48. Vatti RR, Ali F, Teuber S, et al. Hypersensitivity reactions to corticosteroids. Clin Rev Allergy Immunol. 2014;47(1):26-37. (Systematic review)
  49. Lewis J, Foex BA. BET 2: in children, do steroids prevent biphasic anaphylactic reactions? Emerg Med J. 2014;31(6):510-512. (Systematic review)
  50. Choo KJ, Simons FE, Sheikh A. Glucocorticoids for the treatment of anaphylaxis. Cochrane Database Syst Rev. 2012(4):CD007596. (Systematic review)
  51. Fuzak JK, Trainor J. Comparison of the incidence, etiology, and management of anaphylaxis over time. Pediatr Emerg Care. 2013;29(2):131-135. (Retrospective chart review)
  52. Zhang Q, Huang C, Tang T, et al. Comparative neuroprotective effects of methylprednisolone and rosiglitazone, a peroxisome proliferator-activated receptor-gamma following spinal cord injury. Neurosciences (Riyadh). 2011;16(1):46-52. (Prospective; 120 rats)
  53. Bracken MB, Shepard MJ, Hellenbrand KG, et al. Methylprednisolone and neurological function 1 year after spinal cord injury. Results of the National Acute Spinal Cord Injury Study. J Neurosurg. 1985;63(5):704-713. (Retrospective; 256 patients)
  54. Bracken MB, Shepard MJ, Collins WF, et al. A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. Results of the Second National Acute Spinal Cord Injury Study. N Engl J Med. 1990;322(20):1405-1411. (Prospective randomized controlled trial; 487 patients)
  55. Bracken MB, Shepard MJ, Holford TR, et al. Administration of methylprednisolone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury. Results of the Third National Acute Spinal Cord Injury Randomized Controlled Trial. National Acute Spinal Cord Injury Study. JAMA. 1997;277(20):1597-1604. (Prospective; 499 patients)
  56. Bracken MB. Steroids for acute spinal cord injury. Cochrane Database Syst Rev. 2002(3):CD001046. (Systematic review; 8 trials)
  57. Hadley MN, Walters BC, Grabb PA, et al. Guidelines for the management of acute cervical spine and spinal cord injuries. Clin Neurosurg. 2002;49:407-498. (Systematic review)
  58. Pointillart V, Petitjean ME, Wiart L, et al. Pharmacological therapy of spinal cord injury during the acute phase. Spinal Cord. 2000;38(2):71-76. (Retrospective; 106 patients)
  59. Walters BC, Hadley MN, Hurlbert RJ, et al. Guidelines for the management of acute cervical spine and spinal cord injuries: 2013 update. Neurosurgery. 2013;60 Suppl 1:82-91. (Systematic review)
  60. Cheung V, Hoshide R, Bansal V, et al. Methylprednisolone in the management of spinal cord injuries: lessons from randomized, controlled trials. Surg Neurol Int. 2015;6:142. (Systematic review; 330 patients)
  61. * Evaniew N, Belley-Cote EP, Fallah N, et al. Methylprednisolone for the treatment of patients with acute spinal cord injuries: a systematic review and meta-analysis. J Neurotrauma. 2016;33(5):468-481. (Systematic review, meta-analysis; 4 randomized controlled trials and 17 observational studies)
  62. Spapen H, Van Berlaer G, Moens M, et al. Adjunctive steroid treatment in acute bacterial meningitis. “To do or not to do: that is the question”. Acta Clin Belg. 2011;66(1):42-45. (Systematic review)
  63. Esposito S, Semino M, Picciolli I, et al. Should corticosteroids be used in bacterial meningitis in children? Eur J Paediatr Neurol. 2013;17(1):24-28. (Systematic review)
  64. Syrogiannopoulos GA, Hansen EJ, Erwin AL, et al. Haemophilus influenzae type b lipooligosaccharide induces meningeal inflammation. J Infect Dis. 1988;157(2):237-244. (Prospective animal study)
  65. * Brouwer MC, McIntyre P, Prasad K, et al. Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev. 2015(9):CD004405. (Systematic review; 25 studies, 4121 participants)
  66. Glimåker M, Brink M, Naucler P, et al. Betamethasone and dexamethasone in adult community-acquired bacterial meningitis: a quality registry study from 1995 to 2014. Clin Microbiol Infect. 2016;22(9):814.e1-814.e7. (Retrospective; 1746 patients)
  67. Theodoridou K, Vasilopoulou VA, Katsiaflaka A, et al. Association of treatment for bacterial meningitis with the development of sequelae. Int J Infect Dis. 2013;17(9):e707-e713. (Prospective; 2477 patients)
  68. Lebel MH, Freij BJ, Syrogiannopoulos GA, et al. Dexamethasone therapy for bacterial meningitis. Results of two double-blind, placebo-controlled trials. N Engl J Med. 1988;319(15):964-971. (Prospective double-blinded; 200 patients)
  69. Schaad UB, Lips U, Gnehm HE, et al. Dexamethasone therapy for bacterial meningitis in children. Swiss Meningitis Study Group. Lancet. 1993;342(8869):457-461. (Prospective randomized double-blinded study; 115 children)
  70. Peltola H, Roine I, Fernandez J, et al. Adjuvant glycerol and/or dexamethasone to improve the outcomes of childhood bacterial meningitis: a prospective, randomized, double-blind, placebo-controlled trial. Clin Infect Dis. 2007;45(10):1277-1286. (Prospective randomized double-blinded trial; 654 patients)
  71. * Bernardo WM, Aires FT, Sa FP. Effectiveness of the association of dexamethasone with antibiotic therapy in pediatric patients with bacterial meningitis. Rev Assoc Med Bras (1992). 2012;58(3):319-322. (Systematic review; 8 articles)
  72. Syrogiannopoulos GA, Lourida AN, Theodoridou MC, et al. Dexamethasone therapy for bacterial meningitis in children: 2- versus 4-day regimen. J Infect Dis. 1994;169(4):853-858. (Prospective randomized; 118 patients)
  73. Tunkel AR, Hartman BJ, Kaplan SL, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004;39(9):1267-1284. (Professional guidelines)
  74. van de Beek D, Cabellos C, Dzupova O, et al. ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clin Microbiol Infect. 2016;22 Suppl 3:S37-S62. (Professional guidelines)
  75. American Academy of Pediatrics. Haemophilus influenzae infections. In: Pickering LK, Baker CJ, Kimberlin DW, et al eds. Red Book. Elk Grove Village, IL: American Academy of Pediatrics; 2012:345–352. (Book chapter)
  76. Ogunlesi TA, Odigwe CC, Oladapo OT. Adjuvant corticosteroids for reducing death in neonatal bacterial meningitis. Cochrane Database Syst Rev. 2015(11):CD010435. (Systematic review; 2 trials, 132 participants)
  77. McIntyre P. Should dexamethasone be part of routine therapy of bacterial meningitis in industrialised countries? Adv Exp Med Biol. 2005;568:189-197. (Systematic review)
  78. Gries DM, Moffitt DR, Pulos E, et al. A single dose of intramuscularly administered dexamethasone acetate is as effective as oral prednisone to treat asthma exacerbations in young children. J Pediatr. 2000;136(3):298-303. (Prospective; 32 patients)
  79. Schut ES, Brouwer MC, de Gans J, et al. Delayed cerebral thrombosis after initial good recovery from pneumococcal meningitis. Neurology. 2009;73(23):1988-1995. (Case series; 6 patients)
  80. Sidoroff VH, Ylinen MK, Kroger LM, et al. Inhaled corticosteroids and bone mineral density at school age: a follow-up study after early childhood wheezing. Pediatr Pulmonol. 2015;50(1):1-7. (Prospective; 89 patients)
  81. Kelly HW, Sternberg AL, Lescher R, et al. Effect of inhaled glucocorticoids in childhood on adult height. N Engl J Med. 2012;367(10):904-912. (Randomized controlled trial)
  82. Zhang L, Prietsch SO, Ducharme FM. Inhaled corticosteroids in children with persistent asthma: effects on growth. Cochrane Database Syst Rev. 2014(7):CD009471. (Systematic review; 25 trials, 8471 children with mild-to-moderate persistent asthma)
  83. Pruteanu AI, Chauhan BF, Zhang L, et al. Inhaled corticosteroids in children with persistent asthma: dose-response effects on growth. Cochrane Database Syst Rev. 2014(7):CD009878. (Systematic review; 10 trials, 3394 children with mild-to-moderate asthma)
  84. Muley P, Shah M, Muley A. Safety of inhaled fluticasone propionate therapy for pediatric asthma - a systematic review. Curr Drug Saf. 2013;8(3):186-194. (Systematic review; 10 studies)
  85. Lasmar L, Brand PL, Lima AC, et al. Growth velocity in prepubertal children using both inhaled and intranasal corticosteroids. Ann Allergy Asthma Immunol. 2016;116(4):368-370.(Retrospective)
  86. Skoner DP. The tall and the short: repainting the landscape about the growth effects of inhaled and intranasal corticosteroids. Allergy Asthma Proc. 2016;37(3):180-191. (Systematic review)
  87. Drozdowicz LB, Bostwick JM. Psychiatric adverse effects of pediatric corticosteroid use. Mayo Clin Proc. 2014;89(6):817-834. (Systematic review)
  88. Weiss PF, Feinstein JA, Luan X, et al. Effects of corticosteroid on Henoch-SchÖnlein purpura: a systematic review. Pediatrics. 2007;120(5):1079-1087. (Systematic review; 15 articles)
  89. Chartapisak W, Opastirakul S, Hodson EM, et al. Interventions for preventing and treating kidney disease in Henoch-SchÖnlein Purpura (HSP). Cochrane Database Syst Rev. 2009(3):CD005128. (Systematic review; 10 studies, 1230 children)
  90. Katafuchi R, Ninomiya T, Mizumasa T, et al. The improvement of renal survival with steroid pulse therapy in IgA nephropathy. Nephrol Dial Transplant. 2008;23(12):3915-3920. (Retrospective; 702 patients)
  91. Delbet JD, Hogan J, Aoun B, et al. Clinical outcomes in children with Henoch-Schönlein purpura nephritis without crescents. Pediatr Nephrol. 2017;32(7):1193-1199. (Prospective; 92 patients)
  92. Chapter 11: Henoch-Schönlein purpura nephritis. Kidney Int Suppl. 2012;2(2):218-220. (Book chapter)
  93. Reamy BV, Williams PM, Lindsay TJ. Henoch-Schönlein purpura. Am Fam Physician. 2009;80(7):697-704. (Review)
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Accreditation: EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. This activity has been planned and implemented in accordance with the accreditation requirements and policies of the ACCME.

Credit Designation: EB Medicine designates this enduring material for a maximum of 4 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Specialty CME: Included as part of the 4 credits, this CME activity is eligible for 4 Pharmacology CME credits, subject to your state and institutional approval.

Faculty Disclosures: It is the policy of EB Medicine to ensure objectivity, balance, independence, transparency, and scientific rigor in all CME-sponsored educational activities. All faculty participating in the planning or implementation of a sponsored activity are expected to disclose to the audience any relevant financial relationships and to assist in resolving any conflict of interest that may arise from the relationship. In compliance with all ACCME Essentials, Standards, and Guidelines, all faculty for this CME activity were asked to complete a full disclosure statement. The information received is as follows: Dr. Thabet, Dr. Greenfield, Dr. Cantor, Dr. Saulys, Dr. Sellinger, Dr. Claudius, Dr. Horeczko, Dr. Mishler, and their related parties report no significant financial interest or other relationship with the manufacturer(s) of any commercial product(s) discussed in this educational presentation. Dr. Jagoda made the following disclosures: Consultant, Daiichi Sankyo Inc; Consultant, Pfizer Inc; Consultant, Banyan Biomarkers Inc; Consulting fees, EB Medicine.

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Last Modified: 12/12/2018
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