India · Paediatric mg/kg & Adult · Croup · Meningitis · Anti-emetic · COVID-19 · Cerebral Oedema · Decadron · Dexona
🍃 Croup — single dose, no taper
🧠 Cerebral oedema — loading + maintenance
🤢 PONV — single IV dose at induction
🫁 COVID-19 — 6 mg × 10 days if O2 needed
🦠 Meningitis — adjunct before/with antibiotics
💊 No mineralocorticoid — unlike hydrocortisone
| Indication | Paediatric dose | Adult dose | Duration | Taper? |
|---|---|---|---|---|
| Croup — mild/moderate | 0.15 mg/kg oral (max 10 mg) | — | Single dose | No |
| Croup — severe | 0.6 mg/kg oral/IM (max 10 mg) | — | Single dose | No |
| Bacterial meningitis | 0.15 mg/kg IV q6h × 4 days | 10 mg IV q6h × 4 days | 4 days | No |
| PONV prevention | 0.15 mg/kg IV at induction (max 8 mg) | 4–8 mg IV at induction | Single dose | No |
| CINV — moderate chemo | 0.15 mg/kg IV (max 8 mg) | 8–12 mg IV before chemo | Chemo day | No |
| COVID-19 (O2 requiring) | 0.15 mg/kg IV/oral (RECOVERY) | 6 mg OD oral or IV | 10 days max | No |
| Cerebral oedema | 0.5 mg/kg IV loading | 10 mg IV loading then 4 mg q6h | As directed | Yes — taper |
| Severe asthma (IV) | 0.3 mg/kg IV (max 10 mg) | 8 mg IV (or prednisolone oral preferred) | 1–3 doses then switch | No (short) |
| Spinal cord compression | — | 16 mg IV loading then 4 mg qid | Taper over weeks | Yes |
| Pre/post-extubation stridor | 0.25 mg/kg IV q6h × 3 doses | 8 mg IV q6h × 3–4 doses | 3–4 doses | No |
Dexamethasone is a potent synthetic glucocorticoid with approximately 25 times the glucocorticoid potency of hydrocortisone and negligible mineralocorticoid activity — making it the preferred corticosteroid when fluid and electrolyte side effects are undesirable. Its long biological half-life (36–54 hours) allows once-daily dosing for most indications and makes it particularly suited to situations requiring sustained anti-inflammatory or anti-oedema effect, such as cerebral oedema and meningitis. In India, it is available as Decadron, Dexona, and Wymesone in injection and tablet forms.
Dexamethasone has replaced nebulised budesonide as the preferred treatment for croup in most Indian paediatric units due to its oral availability, single-dose efficacy, and reliable absorption. The dose range is 0.15 mg/kg (mild-moderate croup) to 0.6 mg/kg (severe croup), maximum 10 mg, as a single oral dose. Multiple RCTs show that oral dexamethasone and IM dexamethasone are equally effective. A single dose is sufficient — no second dose or taper is required. Effect is seen within 30–60 minutes. The 0.5mg/5ml oral liquid (Dexona) is practical for young children.
The RECOVERY trial established dexamethasone 6 mg once daily for up to 10 days as the first treatment proven to reduce mortality in COVID-19. This benefit is limited to patients requiring supplemental oxygen or mechanical ventilation — in COVID-19 patients who do not require oxygen, dexamethasone does not help and may cause harm by impairing the immune response needed for viral clearance. This dose can be given orally or IV with equivalent efficacy. No tapering is required after a 10-day course.
Dexamethasone 0.15 mg/kg IV (adult: 10 mg) every 6 hours for 4 days should ideally be given immediately before or with the first dose of antibiotics in bacterial meningitis. The benefit is in reducing meningeal inflammation triggered by antibiotic-induced bacterial lysis — if dexamethasone is given after antibiotics have already been started, most of the benefit is lost. Dexamethasone reduces mortality and hearing loss in H. influenzae and pneumococcal meningitis. Evidence for benefit in meningococcal meningitis is less certain but dexamethasone is still recommended pending culture results.
For vasogenic cerebral oedema (tumour, abscess, radiation necrosis): dexamethasone 10 mg IV loading dose followed by 4 mg every 6 hours, then tapered as clinical improvement occurs. Dexamethasone is highly effective for vasogenic oedema but is less effective for cytotoxic oedema (ischaemic stroke, severe TBI). Prolonged high-dose use carries all steroid side effects — hyperglycaemia monitoring is critical in patients who may already have impaired glucose regulation.