- Another trial compared high-dose dexamethasone (20 mg once daily for 5 days, followed by 10 mg once daily for an additional 5 days) to low-dose dexamethasone (6 mg once daily for 10 days) in patients with COVID-19 pneumonia needing oxygen therapy. The high-dose group showed reduced clinical worsening within 11 days after randomization compared to the low-dose group
- A systematic review and meta-analysis of randomized trials found no significant difference in the risk of 28-day all-cause mortality between intermediate- to high-dose dexamethasone and low-dose dexamethasone in patients with COVID-19 requiring respiratory support
- The NIH 2021 guidelines recommend administering dexamethasone in hospitalized patients requiring invasive mechanical ventilation or ECMO
- The IDSA 2023 guidelines recommend administering dexamethasone 6 mg IV or PO daily for 10 days or until discharge in hospitalized critically ill patients with COVID-19
Specific circumstances
- The NIH 2021 guidelines also recommend administering dexamethasone in patients initially treated with remdesivir monotherapy and progressed to requiring invasive mechanical ventilation or ECMO, and continue remdesivir until the treatment course is completed
- The NIH 2021 guidelines recommend not using dexamethasone or other corticosteroids in hospitalized patients with COVID-19 not requiring supplemental oxygen
- The NIH 2021 guidelines recommend not using dexamethasone or other systemic corticosteroids in nonhospitalized patients with mild-to-moderate COVID-19 not requiring supplemental oxygen
In conclusion, the recommended dose of dexamethasone for COVID-19 patients requiring supplemental oxygen is 6 mg once daily, administered either orally or intravenously, for up to 10 days or until discharge. This recommendation is supported by multiple clinical trials and guidelines. However, the optimal dose may vary depending on the severity of the disease and the patient's response to treatment.