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Outpatient Glucocorticosteroids

Bronchiolitis team recommendation: Based on high quality evidence, the Bronchiolitis CPG Team recommends that glucocorticosteriods not be used for the outpatient treatment of the child who presents for the first time with the symptoms of bronchiolitis. We placed high value on avoiding exposure to a medication without evidence to support its use. This recommendation can apply to most patients in most circumstances. Ten studies, summarized in a Cochrane Review (Fernandes et al., 2010) showed that when glucocorticosteriods were given, hospitalization from the outpatient setting was not decreased. Children who received steroids and were then admitted to the hospital did not have a shorter length of stay. However, there is an exploratory report from a large, high quality trial that suggests combining systematic glucocorticosteriods (specifically dexamethasone) with epinephrine may significantly reduce hospital admissions. No short-term adverse effects noted, and the trial was not designed to evaluate long-term effects. Further research is likely to change our confidence in the estimate of the effect.

Literature supporting this recommendation: Sixty four citations were found from the literature search. One Cochrane Database of Systematic Reviews (CDSR) paper is included (Fernandes et al., 2010). Single studies identified in by the Bronchiolitis Team are included in the Fernandes 2010 CDSR, and are not reported upon separately.

Critically Appraised Topic (CAT): Glucocorticosteroids

These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly these guidelines should guide care with the understanding that departures from them may be required at times.