No difference between oral and nebulised steroids in croup
- Report By: Sue Maurice - Consultant in Emergency Medicine
- Search checked by Terry Gilpin - Clinical Fellow in Emergency Medicine
- Institution: Manchester Royal Infirmary
- Current web editor: Ian Maconochie - Paediatric A&E Consultant
- Date Submitted: 1st March 2000
- Date Completed: 1st March 2000
- Last Modified: 20th December 2002
-
Status:
Green (complete)
Three Part Question
In [a child with croup] is [oral dexamethazone better than nebulised budesonide] at [reducing length of stay and reducing croup score]?Clinical Scenario
A 3 year old child attending the emergency department with moderately severe croup. I know that croup responds to steroid therapy, but I want to know whether oral dexamethasone is a better treatment than nebulised budesonide.Search Strategy
Medline 1996-Nov/02 using the OVID interface.[exp croup OR croup ti.ab.sh OR laryngotracheitis ti.ab.sh OR laryngotracheobronchitis ti.ab.sh] AND [budesonide ti.ab.sh OR dexamethasone ti.ab.sh]
Search Outcome
111 papers found of which 63 were irrelevant. The remaining paper is shown in the table.Relevant Paper(s)
| Author, date and country | Patient group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Geelhoed GC and MacDonald WB, 1995, Australia | 80 children (5-158 months) randomised to receive budesonide, dexamethasone or placebo | PRCT | Time to croup score less than 1 | Significantly shorter for both steroid groups (2-3h) vs placebo (8h) | |
| Duration of hospitilisation | Significantly shorter for both steroid groups (12h) vs placebo (20h) |
Comment(s)
There is no significant difference in the clinical effectiveness of oral and nebulised steroids in croup. The effect of simple humidification has not been accounted for in this study.Clinical Bottom Line
Either oral dexamethasone or nebulised budesonide can be used to good effect in moderately severe croup. Dexamethasone is currently much cheaper.References
- Geelhoed GC, MacDonald WB. Oral and inhaled steroids in croup: a randomised, placebo controlled trial. Pediatr Pulmonol 1995;20(6):355-361.