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Prednisolone versus dexamethasone in croup: a randomised equivalence trial
1Emergency Department, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.
Archives of Disease in Childhood
|April 21, 2006
Summary
Oral prednisolone is less effective than dexamethasone for treating croup in children, leading to more frequent re-presentations to medical care. Dexamethasone is the preferred treatment for mild to moderate croup.
Area of Science:
- Pediatric Emergency Medicine
- Pharmacology
- Clinical Trials
Background:
- Croup is a common respiratory illness in children requiring emergency department visits.
- Oral dexamethasone is an established effective treatment for croup.
- Prednisolone offers pharmacokinetic similarities and liquid formulations, making it a potential alternative.
Purpose of the Study:
- To determine if oral prednisolone is equivalent to oral dexamethasone in treating mild to moderate croup in children.
- To compare the efficacy of single oral doses of prednisolone and dexamethasone.
Main Methods:
- A double-blind, randomized, controlled equivalence trial was conducted.
- 133 children aged 3 to 142 months with mild to moderate croup were enrolled.
- Participants received either oral dexamethasone (0.15 mg/kg) or oral prednisolone (1 mg/kg).
Main Results:
- Children receiving prednisolone were significantly more likely to re-present for medical care (29% vs. 7%).
- The difference in re-presentation rates (22%) fell outside the predefined equivalence range (0% to 7.5%).
- No significant differences were observed in other secondary outcomes like croup score or symptom duration.
Conclusions:
- A single oral dose of prednisolone is less effective than dexamethasone for reducing unscheduled medical re-presentations in pediatric croup.
- Dexamethasone demonstrates superior efficacy in managing mild to moderate croup compared to prednisolone.
- These findings support the continued use of dexamethasone as a primary oral treatment for croup.
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