title: Oral betamethasone versus intramuscular dexamethasone for the treatment of mild to moderate viral croup: a prospective, randomized trial.
abstract: OBJECTIVE
  Intramuscular dexamethasone is an effective, but painful, treatment for croup. The effectiveness of betamethasone, an oral, palatable, and equally potent glucocorticoid has not been studied. The purpose of this study was to compare the effectiveness of a single oral dose of betamethasone with intramuscular dexamethasone in the outpatient treatment of mild to moderate croup.
  
  
  METHODS
  Children aged 6 months to 6 years presenting to a tertiary care pediatric emergency department (ED) with a modified Westley croup score of 0 to 11 were randomized to receive either 0.6 mg/kg IM dexamethasone or 0.4 mg/kg PO betamethasone. Croup score, heart rate, respiratory rate, pulse oximetry, and need for supplemental treatments were recorded at study entry and at 1, 2, and 4 hours after treatment. Follow-up data were collected by daily telephone follow-up on persistence of symptoms and the need for additional treatment or physician visits up to 7 days after the ED visit.
  
  
  RESULTS
  Each study group contained 26 patients. Despite randomization, the mean baseline croup score was higher in the dexamethasone group (3.6 +/- 2.6 vs. 2.0 +/- 2.4, P = 0.03). Patients in both groups showed a significant reduction in the croup score after treatment, and there were no significant differences between croup scores at 4 hours (P = 0.18). Similarly, there were no differences between groups in the hospital admission rate, time to resolution of symptoms, need for additional treatments, or number of return ED visits.
  
  
  CONCLUSIONS
  There is no difference between oral betamethasone and intramuscular dexamethasonein the management of mild to moderate viral croup. It is palatable and does not require a nurse for administration, making it a good alternative for ambulatory management.
authors.affiliation: Unit of Emergency Medicine, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel. lamir@clalit.org.il
authors.forename: Lisa
authors.initials: L
authors.lastname: Amir
authors.forename: Henry
authors.initials: H
authors.lastname: Hubermann
authors.forename: Ayelet
authors.initials: A
authors.lastname: Halevi
authors.forename: Meirav
authors.initials: M
authors.lastname: Mor
authors.forename: Marc
authors.initials: M
authors.lastname: Mimouni
authors.forename: Yehezkel
authors.initials: Y
authors.lastname: Waisman
mesh_terms: D000284:Administration, Oral; D001623:Betamethasone / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D003440:Croup / Q000188:drug therapy* / Q000821:virology*; D003907:Dexamethasone / Q000008:administration & dosage*; D004638:Emergency Treatment; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007223:Infant; D007273:Injections, Intramuscular; D008297:Male; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone; D001623:Betamethasone