Corticosteroid — Croup / Bacterial Meningitis / Post-Extubation Stridor / Cerebral Oedema Pregnancy: Antenatal: 12 mg IM every 24 hours × 2 doses given for fetal lung maturation in threatened preterm delivery — established evidence

Dexamethasone (Paediatric)

Brand names: Dexsol, Ozurdex (ophthalmic)

Adult dose

Dose: Cerebral oedema: 8–16 mg IV then 4–8 mg every 6 hours; Bacterial meningitis: 0.15 mg/kg every 6 hours × 4 days

Route: IV or oral

Frequency: Every 6 hours

Max: 40 mg/day

Adult reference — see paediatric dose section

Paediatric dose

Dose: Croup: 0.15 mg/kg oral (max 10 mg) single dose — or 0.6 mg/kg if severe; Bacterial meningitis: 0.15 mg/kg IV every 6 hours × 4 days; Post-extubation stridor: 0.5–1 mg/kg IV (max 8 mg) 30 minutes before extubation; Cerebral oedema: 0.25–0.5 mg/kg loading then 0.1 mg/kg every 6 hours mg/kg

Route: Oral (croup), IV (meningitis, stridor, cerebral oedema)

Frequency: Single dose (croup); every 6 hours (meningitis/oedema)

Max: 10 mg single dose (croup); 8 mg per dose (meningitis/cerebral oedema)

BNFc: croup — oral dexamethasone 0.15 mg/kg preferred over oral prednisolone (longer duration of action, single dose); if oral not possible — nebulised budesonide 2 mg or IM dexamethasone 0.6 mg/kg. Meningitis: give within 4 hours of first antibiotic dose; best evidence for Haemophilus influenzae type b (Hib) and pneumococcal meningitis — reduces deafness. Dexamethasone is 6–7× more potent than prednisolone.

Dose adjustments

Renal

No dose adjustment required

Hepatic

Use with caution in severe hepatic impairment

Paediatric weight-based calculator

Patient weight (kg)

Clinical pearls

Croup: a single oral dose of dexamethasone 0.15 mg/kg is now standard — superior to multiple doses of prednisolone; effects last 24–36 hours; discharge home safe once stridor resolved at rest; nebulised adrenaline for severe stridor (immediate but short-lived relief)
Bacterial meningitis: NICE recommends dexamethasone if age >3 months with confirmed or suspected bacterial meningitis — start with or just before antibiotics; timing critical (benefits limited if antibiotics already given >4 hours); not recommended in meningococcal disease (less evidence)
Post-extubation stridor: pre-extubation dexamethasone reduces stridor by ~50% in at-risk patients (prolonged intubation, prior failed extubation)
No mineralocorticoid activity — dexamethasone does not cause sodium retention (unlike hydrocortisone and prednisolone); preferred for cerebral oedema management

Contraindications

Systemic infection without antimicrobial cover
Bacterial meningitis: avoid if already started antibiotics >4 hours ago (reduced benefit)
Live vaccines

Side effects

Hyperglycaemia
Hypertension
GI disturbance
Immunosuppression
Adrenal suppression (prolonged use)
Mood and behavioural changes
Electrolyte disturbance

Interactions

Phenytoin — reduces dexamethasone levels (CYP3A4 induction)
Rifampicin — markedly reduces dexamethasone levels
NSAIDs — additive GI risk

Monitoring

Blood glucose (hyperglycaemia)
Blood pressure
Electrolytes
Neurological status (meningitis/cerebral oedema)
Stridor assessment (croup — before and after)

Reference: BNF for Children; NICE CG102 (Bacterial Meningitis); Russell AS et al. BMJ 2011 (Croup Dexamethasone); BTS Croup Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways