Prednisolone Versus Dexamethasone for Croup: a Randomized Controlled Trial.

Area of Science:

• Pediatric Emergency Medicine
• Pharmacology
• Clinical Trials

Background:

• Childhood croup treatment often uses prednisolone or dexamethasone without strong evidence.
• A need exists to compare different oral steroid regimens for efficacy and safety.

Purpose of the Study:

• To compare the efficacy of standard-dose dexamethasone (0.6 mg/kg) with low-dose dexamethasone (0.15 mg/kg) and prednisolone (1 mg/kg) in treating childhood croup.
• To assess short-term outcomes including symptom severity and healthcare re-attendance.

Main Methods:

• A prospective, double-blind, noninferiority randomized controlled trial was conducted in two emergency departments.
• 1252 children aged >6 months and weighing ≤20 kg with croup were randomized to receive one of three oral steroid treatments.
• Primary outcomes were the Westley Croup Score at 1 hour and unscheduled medical re-attendance within 7 days.

Main Results:

• Noninferiority was demonstrated for both low-dose dexamethasone and prednisolone compared to standard-dose dexamethasone.
• No significant differences were observed in the Westley Croup Score at 1 hour post-treatment across the groups.
• Re-attendance rates within 7 days did not significantly differ between the treatment groups.

Conclusions:

• Low-dose dexamethasone and prednisolone are noninferior to standard-dose dexamethasone for childhood croup treatment.
• The choice of oral steroid (dexamethasone or prednisolone) does not appear to significantly impact acute or short-term treatment efficacy.