Prednisolone for 3 Days May Be an Alternative to Dexamethasone Single Dose for Management of Mild-to-Moderate Croup Symptoms

EBM Focus - Volume 9, Issue 1

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Cases of mild-to-moderate croup are often treated with corticosteroids, mostly based on results from randomized trials in emergency department settings. A recent Cochrane review demonstrated that corticosteroid treatment (dexamethasone in most trials) improves croup symptoms and reduces return visits or readmissions (Cochrane Database Syst Rev. 2011 Jan 19;(1):CD001955), and a high-quality randomized trial has shown that a single course of dexamethasone reduces symptom severity in children with mild croup (N Engl J Med. 2004 Sep 23;351(13):1306). However, surveys have shown that the type of steroid used can vary across practices. A 3-day course of prednisolone is commonly prescribed by primary care pediatricians, but the clinical evidence supporting its use is limited, especially in settings outside the emergency department. Now, a community-based randomized trial has compared a 3-day course of prednisolone to a single course of dexamethasone in children with mild-to-moderate croup.

A total of 87 children aged 1-8 years were randomized to prednisolone 2 mg/kg/day orally for 3 days vs. a single dose of dexamethasone 0.6 mg/kg orally plus 2 doses of placebo on successive days. All children had croup symptoms for a maximum of 48 hours, and symptoms were classified as mild in 42% and moderate in 58%. Children were followed for 8 days after the completion of treatment. There were no significant differences between groups in the duration of symptoms, nonbarky cough, disturbed parental sleep, or days with stress. Similarly, there was no significant difference in the need for additional health care for croup. However, it is noteworthy that this trial failed to reach its target sample size of 200 children with croup. This may have resulted in inadequate statistical power to rule out clinically meaningful differences between the 2 groups. Still, the findings from this trial demonstrate that prednisolone appears to be a reasonable alternative to dexamethasone for children with mild-to-moderate croup in community practices.

For more information, see the Croup topic in DynaMed.