Muhammad Yusoff Mohd RamdzanMeenal MavinkurveShamini SubramaniamMohd Anas Che NikFahisham TaibHazamaMohamadSuzina Sheikh Abdul Hamid2024-05-282024-05-2820162180-193210.5959/eimj.v8i4.460http://eduimed.usm.my/EIMJ20160804/EIMJ20160804_10.pdfhttps://oarep.usim.edu.my/handle/123456789/6922Volume 8, No. 4Recurrent respiratory papillomatosis (RRP) is a rare cause of childhood stridor which typically presents before the age of five years and results from the vertical transmission of the human papilloma virus. Genotypes 11 and 6 are commonly implicated in RRP. Following vertical transmission, the human papilloma virus (HPV) causes overgrowth of the airway epithelium which causes partial airway obstruction and the symptoms of stridor. The mainstay management is surgical debridement of the papillomata but the recurrence rate subsequent to surgery is high, such that most children will require repeated surgical procedures at regular interval. Medical adjuvant therapy can be used, but data is limited and the medications are used on an off-label basis. This case highlights the ethical considerations that need to be made when using off-label medications in paediatric patients.en-USOff label medication, Respiratory papilomatosis, Evidence based medicine, ChildrenArticle838784