State of the evidence for standard-of-care treatments for croup: are we where we need to be?
BACKGROUND
Croup is a term that groups several different clinical syndromes with inspiratory stridor. The failure to delineate the specific syndromes has led to suboptimal treatment in many instances.


METHODS
A literature review and personal experience have been analyzed.


RESULTS
Specific croup syndromes have been identified. Most croup steroid-treatment studies have failed to adequately identify the specific illness being treated. With 2 exceptions, all studies done to date have been too small to sufficiently evaluate risks of steroids if the risk is 1% or less.


CONCLUSIONS
Three conclusions were reached: (1) no steroid treatment studies of moderate or severe laryngotracheitis have been of adequate size to determine the risk of progressive viral infection or secondary bacterial infection; (2) single dose steroid treatment or limited nebulized use is probably safe; and (3) we should encourage better clinical diagnosis of croup illnesses.
Cherry
James D
JD
Department of Pediatrics, David Geffen School of Medicine at UCLA, University of California-Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095-1752, USA. jcherry@mednet.ucla.edu
D001424:Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D003440:Croup / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D016896:Treatment Outcome; D014777:Virus Diseases / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology / Q000821:virology
D005938:Glucocorticoids