Effectiveness of oral or nebulized dexamethasone for children with mild croup.
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 microg), or placebo. Telephone follow-up was obtained on days 1, 2, 3, 4, and 7.


METHODS
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.
Luria
J W
JW
Division of Emergency Medicine, Children's Hospital Medical Center, 3333 Burnet Ave OSB-4, Cincinnati, OH 45229-3039, USA. joe.luria@chmcc.org
Gonzalez-del-Rey
J A
JA
DiGiulio
G A
GA
McAneney
C M
CM
Olson
J J
JJ
Ruddy
R M
RM
D000280:Administration, Inhalation; D000284:Administration, Oral; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003440:Croup / Q000188:drug therapy*; D003907:Dexamethasone / Q000008:administration & dosage* / Q000627:therapeutic use; D004311:Double-Blind Method; D004636:Emergency Service, Hospital; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D009330:Nebulizers and Vaporizers; D010043:Outcome and Process Assessment, Health Care; D017211:Treatment Failure
D000893:Anti-Inflammatory Agents; D003907:Dexamethasone