Outpatient treatment of moderate croup with dexamethasone: intramuscular versus oral dosing.
OBJECTIVE
Steroid use for the treatment of croup has been supported by several studies, although few have addressed the use of oral dexamethasone for outpatient management. The efficacy of oral (PO) versus intramuscular (IM) dosing of dexamethasone in the outpatient treatment of moderate croup are compared in this study.


METHODS
Patients between the ages of 3 months and 12 years with moderate croup (history or presence of stridor, cyanosis, or retractions) were eligible for enrollment in this single-blind, prospective study. Patients were randomized to receive a single dose (0.6 mg/kg, maximum 8 mg) of IM or PO dexamethasone. Parents were contacted by phone to assess resolution of symptoms and need for further evaluation.


RESULTS
Two hundred seventy-seven patients were enrolled (median age: 2.1 years). One hundred thirty-nine patients received IM dexamethasone, and 138 received PO. At phone follow-up, 141 (51%) had total resolution of symptoms (75 in IM, 66 in PO). Eighty patients (29%) returned for further evaluation (45 in IM, 35 in PO). Twenty-three (8%) received either more steroids, racemic epinephrine, or admission (11 in IM, 12 in PO).


CONCLUSIONS
No statistically significant difference was found in the need for subsequent interventions after a single dose of either IM or PO dexamethasone. A single PO dose of dexamethasone can be effectively and safely used for the outpatient treatment of moderate croup.
Rittichier
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KK
Primary Children's Medical Center, University of Utah, Salt Lake City, Utah, USA. kristine.rittichier@hsc.utah.edu
Ledwith
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CA
D000284:Administration, Oral; D000553:Ambulatory Care; D000893:Anti-Inflammatory Agents; D016009:Chi-Square Distribution; D002675:Child, Preschool; D003120:Colorado; D003440:Croup / Q000188:drug therapy*; D003907:Dexamethasone / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007273:Injections, Intramuscular; D008297:Male; D011897:Random Allocation; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D003907:Dexamethasone