Perth, Australia—Laryngotracheobronchitis, known as croup, is a common childhood infection that usually affects children from age 6 months to 3 years and primarily occurs in the winter months.

It often is treated with either prednisolone or low-dose dexamethasone. A study published in the journal Pediatrics suggests, however, that the treatment of childhood croup lacked a rigorous evidence base despite widespread use.

To remedy that, Perth Children’s Hospitalled researchers compared dexamethasone at 0.6 mg/kg with both low-dose dexamethasone at 0.15 mg/kg and prednisolone at 1 mg/kg.

The prospective, double-blind, noninferiority, randomized, controlled trial was based in one tertiary pediatric emergency department and one urban district emergency department in Perth, Western Australia.

Participants were age 6 months or older with a maximum weight of 20 kg; the patient’s caregivers had to be contactable by telephone and be English-speaking. Exclusion criteria were known prednisolone or dexamethasone allergy, immunosuppressive disease or treatment, steroid therapy or enrollment in the study within the previous 14 days, and a high clinical suspicion of an alternative diagnosis.

The study enrolled 1,252 participants and randomly assigned them to receive dexamethasone (0.6 mg/kg; n = 410), low-dose dexamethasone (0.15 mg/kg; n = 410), or prednisolone (1 mg/kg; n = 411). Defined as primary outcome measures were Westley Croup Score determined 1 hour after treatment and unscheduled medical reattendance during the 7 days after treatment.

Results indicate that mean Westley Croup Score at baseline was 1.4 for dexamethasone, 1.5 for low-dose dexamethasone, and 1.5 for prednisolone. Adjusted difference in scores at 1 hour, compared with dexamethasone, was 0.03 (95% confidence interval -0.09-0.15) for low-dose dexamethasone and 0.05 (95% confidence interval -0.07-0.17) for prednisolone, according to the researchers.

In addition, reattendance rates were 17.8% for dexamethasone, 19.5% for low-dose dexamethasone, and 21.7% for prednisolone (not significant [P = .59 and .19]).

“Noninferiority was demonstrated for both low-dose dexamethasone and prednisolone,” study authors conclude. “The type of oral steroid seems to have no clinically significant impact on efficacy, both acutely and during the week after treatment.”

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