Pediatric croup: no clear winner in dexamethasone vs prednisolone trial

  • Parker CM & al.
  • Pediatrics
  • 15 Aug 2019

  • International Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • 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.

Key results

  • 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.

Study design

  • 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. 

Limitations

  • Limited to 2 Australian centers; generalizability unknown.

Please confirm your acceptance

To gain full access to GPnotebook please confirm:

By submitting here you confirm that you have accepted Terms of Use and Privacy Policy of GPnotebook.

Submit