Glucocorticoids for croup in children.

Area of Science:

• Pediatric Emergency Medicine
• Pharmacology
• Clinical Trials

Background:

• Glucocorticoids are a primary treatment for croup in children.
• Existing evidence supports their efficacy, but ongoing updates are crucial for clinical relevance.
• This review is an updated analysis of previous findings from 1999, 2004, 2011, and 2018.

Purpose of the Study:

• To evaluate the effects and safety of glucocorticoids for treating croup in children up to 18 years old.
• To compare different glucocorticoids, dosages, and administration methods.
• To assess outcomes including symptom severity, hospital admissions, and adverse events.

Main Methods:

• Systematic review and meta-analysis of 45 randomized controlled trials (RCTs) involving 5888 children.
• Searched major databases including Cochrane Library, MEDLINE, and Embase up to March 2022.
• Assessed risk of bias using the Cochrane risk of bias tool and certainty of evidence with the GRADE approach.

Main Results:

• Glucocorticoids significantly reduce croup scores compared to placebo at 2, 6, and 12 hours (low to very low certainty evidence).
• Dexamethasone showed a probable reduction in return visits/re-admissions and supplemental glucocorticoid use compared to other glucocorticoids (moderate certainty evidence).
• A lower dose of dexamethasone (0.15 mg/kg) may be as effective as the standard dose (0.60 mg/kg) in reducing croup severity at 24 hours, but evidence is moderate to very low certainty.

Conclusions:

• The effectiveness of glucocorticoids in reducing croup symptoms, hospital stays, and readmissions remains consistent.
• A lower dose of dexamethasone (0.15 mg/kg) shows potential for similar efficacy to the standard dose (0.60 mg/kg).
• Further RCTs are recommended to solidify the evidence for low-dose dexamethasone in croup treatment.