Pediatric croup: no clear winner in dexamethasone vs prednisolone trial

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

  • International Clinical Digest
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  • 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. 


  • Limited to 2 Australian centers; generalizability unknown.

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