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Comparison between single-dose oral prednisolone and oral dexamethasone in the treatment of croup: a
Alvina Asif1, Asma Tayyab1, Shaista Qazi1
1Islamabad Medical and Dental College.
Insights
Single-dose oral dexamethasone effectively reduced croup scores in children compared to prednisolone. This finding suggests dexamethasone as a preferred treatment for pediatric croup.
Area of Science:
- Pediatric Respiratory Medicine
- Clinical Pharmacology
- Evidence-Based Medicine
Background:
- Croup is a frequent pediatric respiratory illness, contributing to 15% of annual pediatric respiratory tract infection visits.
- Corticosteroids are standard treatment for moderate to severe croup.
- Oral dexamethasone and prednisolone are commonly used, but direct comparisons are valuable.
Purpose of the Study:
- To compare the efficacy of single-dose oral prednisolone versus single-dose oral dexamethasone in treating croup.
- To evaluate the mean change in the Westley Croup Score (WCS) as the primary outcome measure.
Main Methods:
- A randomized-controlled trial was conducted involving 226 children with a WCS of 2 or more.
- Participants were randomized to receive either oral dexamethasone (0.15 mg/kg) or oral prednisolone (1 mg/kg).
- Croup scores and clinical observations were assessed at 4 hours post-administration.
Main Results:
- A significant reduction in the mean Westley Croup Score was observed in the dexamethasone group compared to the prednisolone group at 4 hours (P=0.0005).
- The average age of participants was 2.88 years, with 57.1% males.
- No statistically significant differences were found in respiratory rate, pulse rate, or oxygen saturation between the groups.
Conclusions:
- Single-dose oral dexamethasone (0.15 mg/kg) is effective in reducing croup scores in children.
- Further research is needed to explore efficacy in severe croup and the potential role of multiple-dose corticosteroid therapy.
Abstract:
Croup is a common respiratory illness in children, accounting for 15% of annual clinic and emergency department visits for pediatric respiratory tract infections. We aimed to compare single-dose oral prednisolone with single-dose oral dexamethasone in the treatment of croup in terms of mean change in the Westley Croup Score.
Setting:
Emergency Department of Children Hospital.
Duration:
Six months from December 2017 to June 2022.
Design:
Randomized-controlled trial.
Subjects And Methods:
A total of 226 children with Westley Croup Score 2 or more were included in this study. Patients were randomized into two groups, 113 patients received a single dose of 0.15 mg/kg of oral dexamethasone, while 113 patients received a single dose of 1 mg/kg of oral prednisolone. Croup score and other clinical observations were repeated at 4 h and recorded in the questionnaire.
Results:
The average age of the patients was 2.88±1.17 years. There were 129 (57.1%) males and 97 (42.9%) females. At 4 h, a significant reduction in mean Westley Croup Score was observed in group dexamethasone as compared with group prednisolone (P=0.0005).
Conclusions:
Our trial demonstrated that oral dexamethasone at a dose of 0.15 mg/kg is effective in reducing the total croup score but there were no statistical differences in respiratory rate, pulse rate, and oxygen saturation between groups. Future studies are required to determine if these treatments differ in efficacy for severe croup and whether there is a role for multiple-dose corticosteroid therapy in some patients.
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