University of Michigan
Department of Pediatrics
Evidence-Based Pediatrics Web Site

Question

• Are oral steroids as efficacious as IM dexamethasone in the outpatient treatment of children with croup?

Clinical Bottom Lines

1. No significant difference in the incidence of return visits, need for further treatment or admission between those patients with moderate croup who received PO vs. IM dexamethasone.
2. No significant difference between caretaker report of symptoms at follow-up between the 2 groups.
3. Oral dexamethasone is more cost-effective than IM administration and is less painful for the child.

Summary of Key Evidence

1. In a randomized controlled study comparing the administration of 0.6mg/kg of dexamethasone for moderate croup, there was no significant increased risk of return failure between PO and IM administration.
2. Those patients who were sicker at the time of presentation were more likely to return and require additional treatment.
3. Placebo control not used in this study as steroid use in croup has generally been accepted to improve symptoms.

Additional Comments

• Some studies have suggested that lower doses of dexamethasone (0.15mg/kg) are as efficacious.
• Blinded RCT shows oral prednisolone may be useful until a palatable and cost-effective way to deliver dexamethasone is devised.
• Dexamethasone is approximately 10 times as potent as prednisolone, with a half-life of 36-54 hrs vs.18-36 hrs for prednisolone.
  

Citation

1. Rittichier KK, Ledwith CA. Outpatient treatment of moderate croup with dexamethasone: intramuscular versus oral dosing. Pediatrics 2000; 106:1344-8.
2. Klassen TP. Glucocorticoids in the treatment of croup: barking up the right tree. CMAJ 1998; 159:1121-2.
3. Klassen TP. Craig WR. Moher D. Osmond MH. Pasterkamp H. Sutcliffe T. Watters LK. Rowe PC. Nebulized budesonide and oral dexamethasone for treatment of croup: a randomized controlled trial. JAMA 1998; 279:1629-32.
4. Brown JC, Klassen TP. “Croup”, Evidence Based Pediatrics and Child Health, pp 215-221.
5. See also Steroids Are Effective in Croup. 

CAT Author: Jennifer J. King, MD

CAT Appraisers: Jon Fliegel, MD

Date appraised: November 2, 2001