Single dose dexamethasone can help croup
A single dose of oral dexamethasone can offer benefits in mild croup, Canadian researchers have found.
Their trial was conducted at four paediatric emergency departments and
involved some 720 children with mild croup randomly assigned to receive
0.6mg/kg oral dexamethasone or placebo.
The primary outcome was whether the patient visited a doctor again for
croup within seven days after treatment. This was significantly lower
in the corticosteroid group (7.3 per cent versus 15.3 per cent with placebo).
In the dexamethasone group there was also quicker resolution of the symptoms
of croup, less lost sleep and less stress for the parents.
The researchers, from Canada’s paediatric emergency network, say
that the drug leads to “small but important clinical and economic
benefits”. They add that although the long term effects of this
treatment are not known, they now advise dexamethasone use in most, if
not all, children with croup (New England Journal of Medicine 2004;351:1306).
Commenting on the study, US paediatrician Perri Klass, Boston Medical
Centre, says that, before this trial, corticosteroids were sometimes
used in mild croup, without evidence of their benefit. She comments that,
while the use of steam for mild croup gave parents a useful task, its
efficacy had not been well supported by objective studies.
The British National Formulary currently advocates “no specific
treatment” for mild croup. However, with even “reassuringly” mild
croup, Dr Klass outlines how the small but important gains seen with
dexamethasone could make a major difference (ibid, p1283). |
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