Oral dexamethasone is effective in children with mild croup

מתוך medicontext.co.il
By Michelle Chard

NEW YORK (Reuters Health) – Children with mild croup benefit from a single dose of oral dexamethasone, more so than from a nebulized dose, according to a report in the December issue of the Archives of Pediatric and Adolescent Medicine.

Dr. Joseph W. Luria, of Children's Hospital Medical Center, in Cincinnati, Ohio, and colleagues examined the efficacy of oral dexamethasone or nebulized dexamethasone sodium phosphate in children with mild croup in a double-blind, placebo-controlled trial.

Two hundred sixty-four children (6 months to 6 years of age) with croup symptoms for fewer than 48 hours were randomly assigned to receive 0.6 mg/kg oral dexamethasone (n = 85), 160 µg nebulized dexamethasone sodium phosphate (n = 91), or placebo (n = 88). The researchers obtained telephone follow-up on days 1, 2, 3, 4, and 7.

The team notes that 221 patients (84%) were available for follow-up on day 7. Treatment failure occurred in 3 patients (4%) in the oral dexamethasone group, compared with 12 patients (16%) and 10 patients (14%) in the nebulized dexamethasone and placebo groups, respectively (p = 0.05).

"Ten children (13%) in the oral dexamethasone-treated group sought a second medical evaluation during the 7 days following enrollment," the investigators report. "This compares with 27 (33%) in the nebulized dexamethasone-treated group and 29 (37%) in the placebo-treated group, respectively (p = 0.002)."

Greater clinical improvements on day 1 were reported by caregivers of oral dexamethasone-treated children compared with the other groups (p < 0.001).

"Further studies may help with specific dosing questions and whether inhaled dexamethasone is of any value," Dr. Luria and colleagues conclude.

Dr. Luria commented to Reuters Health that "since croup symptoms are typically worse at night, dexamethasone treatment may help children rest more comfortably."

As for future research, Dr. Luria mentioned Dr. Gary Geelhoed in Australia, who "is using a smaller dose of dexamethasone with similar results. I would like to validate those results with another study or try even a lower dose."

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