Friday, October 30, 2009

Epinephrine and dexamethasone for viral wheeze in infants

There is uncertainty about the value of inhaled bron­chodilators and steroids for infants who wheeze. Now a multicentre trial in Canada has shown that treatment with oral dexamethasone and inhaled epinephrine (adrenaline) in the emergency depart­ment reduced rates of hospital admission.

The trial was carried out at eight centres during December to April in 2004–2007. A total of 800 infants aged 6 weeks–12 months (median age, 5 months) with a diagnosis of acute bronchiolitis (defined as a first episode of wheezing associated with signs of an upper respiratory tract infection during the peak respiratory syncytial virus season) were randomized to four treatment groups in the emergency department: epinephrine plus dexam­ethasone (ED), epinephrine plus placebo (EP), dex­amethasone plus placebo (DP), and double placebo (PP). Epinephrine was given as two doses each of 3 mL of 1:1,000 solution via a nebulizer. Dexam­ethasone was given orally in an initial dose of 1 mg/kg followed by five doses of 0.6 mg/kg at 24­hour intervals. Rates of hospital admission by day 7 were 17% (ED), 24% (EP), 26% (DP) and 26% (PP). There was a significant 35% risk reduction in the ED group, but this result became insignificant after statistical adjustment.

Giving oral dexamethasone and inhaled epine­phrine to infants with viral wheeze (paediatricians in Britain might give a diagnosis of wheezy bronchitis) may reduce the need for hospital admission.

Plint AC, et al. Epinephrine and dexamethasone in children with bronchiolitis. NEJM 2009;360:2079–2089; Frey U, von Mutius E. The challenge of managing wheezing in infants. Ibid: 2130–2133 (editorial).

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