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No difference between oral and nebulised steroids in croup

Three Part Question

In [a child with croup] is [oral dexamethazone better than nebulised budesonide] at [reducing length of stay and reducing croup score]?

Clinical Scenario

A 3 year old child attending the emergency department with moderately severe croup. I know that croup responds to steroid therapy, but I want to know whether oral dexamethasone is a better treatment than nebulised budesonide.

Search Strategy

Medline 1996-Nov/02 using the OVID interface.
[exp croup OR croup OR laryngotracheitis OR laryngotracheobronchitis] AND [budesonide OR dexamethasone]

Search Outcome

111 papers found of which 63 were irrelevant. The remaining paper is shown in the table.

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
Geelhoed GC and MacDonald WB,
80 children (5-158 months) randomised to receive budesonide, dexamethasone or placeboPRCTTime to croup score less than 1Significantly shorter for both steroid groups (2-3h) vs placebo (8h)
Duration of hospitilisationSignificantly shorter for both steroid groups (12h) vs placebo (20h)


There is no significant difference in the clinical effectiveness of oral and nebulised steroids in croup. The effect of simple humidification has not been accounted for in this study.

Clinical Bottom Line

Either oral dexamethasone or nebulised budesonide can be used to good effect in moderately severe croup. Dexamethasone is currently much cheaper.


  1. Geelhoed GC, MacDonald WB. Oral and inhaled steroids in croup: a randomised, placebo controlled trial. Pediatr Pulmonol 1995;20(6):355-361.