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Three Part Question

In [patients with mild to moderate croup] is [oral dexamethasone better than oral prednisilone] at [improving outcome]?

Clinical Scenario

A 3 year old boy arrives in the emergency department in the early hours of the morning. His mother reports that he has been unwell for 24 hours with a barking cough. On examination he is well and active but has stridor at rest. His temperature is normal, there is no indrawing and oxygen saturations are normal. You know that oral steroids reduce the length of illness and need for hospital admission but are unsure whether to use oral dexamethasone or oral prednisilone.

Search Strategy

MEDLINE 1966-02/03 and EMBASE 1980-02/03 using the OVID interface.
[exp prednisilone OR prednisilone$.mp OR exp prednisone OR prednidsone$.mp OR exp steroids OR steroid$.mp OR exp dexamethasone OR dexamethasone$.mp] AND [exp croup OR croup$.mp OR laryngotracheobronchitis.mp OR laryngotracheobronchitis$.mp OR laryngotracheitis.mp OR laryngotracheitis$.mp] LIMIT to hman and English.

Search Outcome

Altogether 139 papers identified. None answer the question.

Comment(s)

Croup is a common problem in the paediatric population. Oral steroids are as effective as nebulised steroids and are cheaper. Oral dexamethasone has an effective half-life of 48 hours compared with 24 hours for prednisilone. Unfortunately there is no data directly comparing the efficacy of these two treatments.

Clinical Bottom Line

There is no evidence available to answer this question. Local advice should be followed.