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Nebulized Budesonide and Oral Dexamethasone for Treatment of Croup
A Randomized Controlled Trial
Terry P. Klassen, MD;
William R. Craig, MD, CM;
David Moher, MSc;
Martin H. Osmond, MD, CM;
Hans Pasterkamp, MD;
Terry Sutcliffe, BA;
Lise K. Watters, MD;
Peter C. Rowe, MD
JAMA. 1998;279:1629-1632.
Context.— The effectiveness of glucocorticoids for patients with croup is well established but it remains uncertain which glucocorticoid regimen is most effective.
Objective.— To determine the effectiveness of 3 glucocorticoid regimens in patients with croup.
Design.— Randomized controlled trial with parallel design.
Setting.— Emergency departments of 2 Canadian pediatric tertiary care hospitals.
Participants.— Children with a clinical syndrome consistent with croup, aged 3 months to 5 years, with a croup score of 2 or greater following at least 15 minutes of mist therapy.
Interventions.— Oral dexamethasone, 0.6 mg/kg, and nebulized placebo; oral placebo and nebulized budesonide, 2 mg; or oral dexamethasone, 0.6 mg/kg, and nebulized budesonide, 2 mg.
Main Outcome Measures.— Westley croup score (primary outcome), hospital admission rates, time spent in the emergency department, return visits to the emergency department, or ongoing symptoms at 1 week.
Results.— The mean change in the croup score from baseline to the final study assessment was -2.3 (95% confidence interval [CI], -2.6 to -2.0) in the budesonide group (n=65), -2.4 (95% CI, -2.6 to -2.2) in the dexamethasone group (n=69), and -2.4 (95% CI, -2.7 to -2.1) in the budesonide and dexamethasone group (n=64, P=.70).
Conclusions.— Based on the similar outcomes in the 3 groups, oral dexamethasone is the preferred intervention because of its ease of administration, lower cost, and more widespread availability.
From the Departments of Pediatrics (Drs Klassen, Osmond, and Watters, Ms Moher, and Mr Sutcliffe), and Epidemiology and Community Medicine (Dr Klassen and Mr Moher), University of Ottawa, Ottawa, Ontario; the Department of Child Health, University of Manitoba, Winnipeg (Drs Craig and Pasterkamp); and the Department of Pediatrics, Johns Hopkins University, Baltimore, Md (Dr Rowe).
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