Nebulized budesonide and oral dexamethasone for treatment of croup: a randomized controlled trial.
BACKGROUND
The effectiveness of glucocorticoids for patients with croup is well established but it remains uncertain which glucocorticoid regimen is most effective.


OBJECTIVE
To determine the effectiveness of 3 glucocorticoid regimens in patients with croup.


METHODS
Randomized controlled trial with parallel design.


METHODS
Emergency departments of 2 Canadian pediatric tertiary care hospitals.


METHODS
Children with a clinical syndrome consistent with croup, aged 3 months to 5 years, with a croup score of 2 or greater following at least 15 minutes of mist therapy.


METHODS
Oral dexamethasone, 0.6 mg/kg, and nebulized placebo; oral placebo and nebulized budesonide, 2 mg; or oral dexamethasone, 0.6 mg/kg, and nebulized budesonide, 2 mg.


METHODS
Westley croup score (primary outcome), hospital admission rates, time spent in the emergency department, return visits to the emergency department, or ongoing symptoms at 1 week.


RESULTS
The mean change in the croup score from baseline to the final study assessment was -2.3 (95% confidence interval [CI], -2.6 to -2.0) in the budesonide group (n = 65), -2.4 (95% CI, -2.6 to -2.2) in the dexamethasone group (n = 69), and -2.4 (95% CI, -2.7 to -2.1) in the budesonide and dexamethasone group (n = 64, P = .70).


CONCLUSIONS
Based on the similar outcomes in the 3 groups, oral dexamethasone is the preferred intervention because of its ease of administration, lower cost, and more widespread availability.
Klassen
T P
TP
Department of Pediatrics, University of Ottawa, Ontario, Canada. terry.klassen@sympatico.ca
Craig
W R
WR
Moher
D
D
Osmond
M H
MH
Pasterkamp
H
H
Sutcliffe
T
T
Watters
L K
LK
Rowe
P C
PC
D000281:Administration, Intranasal; D000284:Administration, Oral; D019819:Budesonide / Q000008:administration & dosage* / Q000627:therapeutic use; D002675:Child, Preschool; D003440:Croup / Q000188:drug therapy*; D003907:Dexamethasone / Q000008:administration & dosage* / Q000627:therapeutic use; D004636:Emergency Service, Hospital; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D008297:Male; D009330:Nebulizers and Vaporizers; D016896:Treatment Outcome
D005938:Glucocorticoids; D019819:Budesonide; D003907:Dexamethasone