Choosing Wisely:

Don’t use systemic corticosteroids in children younger than two years with an uncomplicated lower respiratory tract infection

Rationale and Comments: Published guidelines recommend that corticosteroid medications not be used routinely in the management of bronchiolitis. Furthermore, additional studies in patients with other viral lower respiratory tract infections have failed to demonstrate any benefits.
Sponsoring Organizations:
  • Society of Hospital Medicine (Pediatric)
  • Sources:
  • American Academy of Pediatrics guidelines
  • Cochrane Database of Systematic Reviews
  • Disciplines:
  • Pediatric
  • Infectious disease
  • Pulmonary medicine
  • References: • American Academy of Pediatrics. Diagnosis and management of bronchiolitis. Pediatrics. 2006;118(4):1774-93.
    • Klassen TP, et al. Dexamethasone in salbutamol-treated inpatients with acute bronchiolitis: a randomized, controlled trial. J Pediatr. 199;130(2):191-6.
    • Patel H, et al. Glucocorticoids for acute viral bronchiolitis in infants and young children. Cochrane Database Syst Rev. 2004;(3):CD004878.
    • De Boeck K, et al. Respiratory syncytial virus bronchiolitis: a double-blind dexamethasone efficacy study. J Pediatr. 1997;131(6):919-21.
    • Von Woensel JBM, et al. Viral lower respiratory tract infection in infants and young children, BMJ. 2003;327(7405):36-40.
    • Panickar J, et al. Oral prednisolone for preschool children with acute virus-induced wheezing. N Engl J Med. 2009;360(4):329-38.

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