 |
|
Effectiveness of Oral or Nebulized Dexamethasone for Children With Mild Croup
Joseph W. Luria, MD;
Javier A. Gonzalez-del-Rey, MD;
Gregg A. DiGiulio, MD;
Constance M. McAneney, MD;
Jennifer J. Olson, MD;
Richard M. Ruddy, MD
Arch Pediatr Adolesc Med. 2001;155:1340-1345.
Objective To assess the efficacy of oral dexamethasone or nebulized dexamethasone
sodium phosphate in children with mild croup.
Methods Double-blind, placebo-controlled study of 264 children between 6 months
and 6 years of age with symptoms of croup for fewer than 48 hours. Patients
were excluded if they received racemic epinephrine or corticosteroid treatment.
Other exclusion criteria included corticosteroid treatment during the 14 days
prior to enrollment or complicating medical condition. Subjects randomly received
oral dexamethasone (0.6 mg/kg), nebulized dexamethasone sodium phosphate (160
µg), or placebo. Telephone follow-up was obtained on days 1, 2, 3, 4,
and 7.
Main Outcome Measures The primary outcome measure was treatment failure, defined as receiving
corticosteroid or racemic epinephrine treatment during the 7 days after enrollment
in the study. Secondary outcome measures included seeking additional care
and the parental assessments of the patients' condition obtained during follow-up
(worse, same, better, or gone).
Results Eighty-five patients received oral dexamethasone, 91 received nebulized
dexamethasone, and 88 received placebo. There were 3 treatment failures in
the oral dexamethasone–treated group, 12 in the nebulized dexamethasone–treated
group, and 10 in the placebo-treated group (P = .05).
Ten children in the oral dexamethasone–treated group sought additional
care compared with 27 and 29 in the nebulized dexamethasone–treated
and placebo-treated groups, respectively (P = .002).
Parents of children in the oral dexamethasone–treated group reported
greater improvement on day 1 (P<.001) compared
with the nebulized dexamethasone–treated and placebo-treated groups.
Conclusions Children with mild croup who receive oral dexamethasone treatment are
less likely to seek subsequent medical care and demonstrate more rapid symptom
resolution compared with children who receive nebulized dexamethasone or placebo
treatment.
From the Division of Emergency Medicine, Children's Hospital Medical
Center, Cincinnati, Ohio (Drs Luria, Gonzalez-del-Rey, DiGiulio, McAneney,
and Ruddy); and the Section of Emergency Medicine, Mayo Eugenio Litta Children's
Hospital, Mayo Clinic, Rochester, Minn (Dr Olson).
Corresponding author and reprints: Joseph Luria, MD, Division of
Emergency Medicine, Children's Hospital Medical Center, 3333 Burnet Ave OSB-4,
Cincinnati, OH 45229-3039 (e-mail: joe.luria{at}chmcc.org).
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Use of Corticosteroids in Treating Infectious Diseases
McGee and Hirschmann
Arch Intern Med 2008;168:1034-1046.
ABSTRACT
| FULL TEXT
A Randomized Trial of a Single Dose of Oral Dexamethasone for Mild Croup
Bjornson et al.
NEJM 2004;351:1306-1313.
ABSTRACT
| FULL TEXT
Oral dexamethasone led to fewer treatment failures than did nebulised dexamethasone or placebo in children with mild croup
Paton
Evid. Based Med. 2002;7:113-113.
FULL TEXT
Oral or Nebulized Steroid: Which Is Better for Croup?
JWatch Emergency Med. 2002;2002:4-4.
FULL TEXT
Corticosteroids for Children with Mild Croup
JWatch General 2002;2002:3-3.
FULL TEXT
|
