- In the choice of oral steroids for pediatric croup, low-dose dexamethasone vs prednisolone yields no clear winner in terms of efficacy, acutely or in the week after treatment.
Why this matters
- Choice between these steroids for croup does not seem to matter, and either is effective.
- Vs dexamethasone, difference in croup scores at 1 hour was:
- 0.03 (95% CI, −0.09 to 0.15) for low-dose dexamethasone,
- 0.05 (95% CI, −0.07 to 0.17) for prednisolone, and
- Upper limits of the CIs were within the present 0.5 noninferiority margin.
- Unscheduled return visit rates in following week:
- 17.8% dexamethasone vs;
- 19.5% for low-dose dexamethasone vs;
- 21.7% for prednisolone; and
- Differences vs dexamethasone were not significant.
- Children having prednisolone had significantly greater likelihood of receiving more doses (P=.02).
- Median length of stay, need for nebulized epinephrine or repeat epinephrine, and posttreatment vomiting incidence did not differ among groups.
- No intubations, ICU admissions.
- Prospective, double-blinded randomized controlled trial, Australian pediatric emergency departments.
- 1252 children were randomly allocated to dexamethasone (0.6 mg/kg; n=410), low-dose dexamethasone (0.15 mg/kg; n=410), prednisolone (1 mg/kg; n=411).
- Croup scored using Westley Croup Score at 1 hour and at any unscheduled reattendance in following week.
- Funding: Princess Margaret Hospital Foundation.
- Limited to 2 Australian centers; generalizability unknown.