Objective:To determine whether single intramuscular injection of dexamethasone cost-effective in the treatment of acute bronchiolitis in infancyDesign: A randomized double-blind controlled trialSetting:Pediatric Wards, Srinagarind Hospital, Khan Kaen University and Khan Kaen Hospital,Ministry of Public Health, ThailandPatients and Methods:174 infants who were hospitalized with acute bronchiolitis and met the eligiblecriteria, were randomly allocated to receive single intramuscular injection of dexamethasone(0.6 mg/kg) or placebo as a control. The study drug and placebo were prepared and labelthe code number randomly, using the block randomization, by the pharmacist who did notinvolve in the patient care.Outcome and o w m e measurement:The primary outcome was the duration of symptom free, defined as wheezing score 0or 1  ,retraction muscle score of  0 and O2, saturation ~95% . Secondary outcome were theduration of oxygen therapy, the length of hospital stay, the side effects of treatment and thecosts of treatment under both health care provider perspective and patent perspective.Results:174 children, aged between 1 month and 2 years. 63.2% male were randomlyallocated to receive dexamethasone in 89 and placebo in 85 patients. There were nostatistical different in the base line demographic data as well as the severity of the diseaseat the time of enrolment.Dexamethasone significantly decreased the mean duration of symptoms, the meanduration of oxygen therapy and the mean length of hospital stay by 11.8, 16.6 and 13.4hours, respectively, when compared to placebo. (95%CI, p = 3.9-19.7, 0.004; 5.8-27.3,.0003, 2.6-24.2, 0.016). There were very few minor side effects of the medication and no significanct between the two groups. Economic outcome: This study demonstrates statistically significant decrease in thecost of treatment in dexamethasone group compared to the placebo group under bothhealth care provider perspective and patient perspective.1) Health care provider perspective: The mean total cost of disease decreasedfrom 3,827.24 ± 2,404.22 Baht in dexamethasone group to 2,772.30 ± 1,664.08Baht in placebo group: 30.8% (p <0.001) with median cost saved 707.75 Bahtper patient.2) Patient perspective: The mean total cost of disease decreased from 3,379.77 ±2,220.26 Baht in dexamethasone group to 2,409.33 ± 1,687.20 Baht in placebogroup; 26.3% (p <0.001) with median cost saved 481.74 Baht per patient.Conclusion:Single intramuscular injection of 0.6 mg/kg dexamethasone was cost effective in thetreatment of acute bronchiolitis in infancy. It should be recommended for standardtreatment of this disease. The further research questions should be: does oraldexamethasone or prednisolone decrease the duration of symptoms ; does dexamethasonedecrease the hospitalization rate.

มหาวิทยาลัยขอนแก่น ปี 2548

dexamethasone, Bronchiolistis, dexamethazone, steriod