A Systematic Review and Comprehensive Critical Analysis Examining the Use of Prednisolone for the Treatment of Mild to Moderate Croup

Abstract

Background:Many randomised control trials and systematic reviews have examined the benefits of glucocorticoids for the treatment of croup in children, but they have reported mainly on dexamethasone as an oral treatment for croup. No systematic reviews have examined prednisolone alone.Aim:To determine in a systematic review of the literature whether a single dose of oral prednisolone is as effective as a single dose of dexamethasone for reducing croup symptoms in children.Search Strategy:A detailed search was conducted on the following databases: CINAHL, MEDLINE EBSCO, MEDLINE, OVID, PubMed, The Cochrane Library, ProQuest, EMBASE, JBI, Sum search, and OpenGrey. Study authors were contacted.Selection Criteria:Randomised Controlled Trials, clinical trials or chart reviews which examined children with croup who were treated with prednisolone alone, or when prednisolone was compared to a dexamethasone treatment and the effectiveness of the intervention was objectively measured using croup scores and re-attendance as primary outcomes.Data Collection and Analysis:Following PRISMA guidelines for systematic reviews, relevant studies were identified. Scores were graded agreed by two independent reviewers using QualSyst.Main Results:Four studies met the inclusion criteria, but were too heterogeneous to combine in statistical meta-analysis. The result suggests that although prednisolone appears as effective as dexamethasone when first given, it is less so for preventing re-presentation. Trial sample sizes were small, making firm conclusions difficult, however, a second dose of prednisolone the following day may be useful. More research including cost-benefit analysis is needed to examine the efficacy of prednisolone compared to dexamethasone.

Croup

“…1,8 Dexamethasone is preferred over prednisolone, which has a slower onset and isn't as effective for preventing symptom recurrence and readmissions. 4,20 Dexamethasone can be given orally, I.V., or I.M. With an onset of action between 30 minutes and 6 hours, expect to see improved symptoms at 2 hours.…”

“…It's been found to reduce length of hospitalization or ED stay 1,8. Dexamethasone is preferred over prednisolone, which has a slower onset and isn't as effective for preventing symptom recurrence and readmissions 4,20. Dexamethasone can be given orally, I.V., or I.M.…”

Modern Approaches to the Management of Children with Acute Obstructive Laryngitis and Epiglottitis

“…Для терапии крупа рекомендуется применение глюкоко ртикоидов (для ингаляционного применения) и/или кортикостероидов системного действия (дексаметазон, преднизолон) всем пациентам [20,28,29,31]. (Уровень убедительности рекомендаций -A; уровень достоверности доказательств -1.…”

“…При отсутствии дексаметазона пациенту может быть назначен преднизолон в эквивалентной дозе (1 или 2 мг/кг преднизолона соответствуют 0,15 и 0,6 мг/кг дексаметазона) [31], однако при сходной эффективности, особенно при крупе легкого и среднетяжелого течения, после терапии преднизолоном выше риск повторного возникновения симптомов крупа, что может потребовать повторного введения препарата [29].…”

Quality Assessment of Brands of Prednisolone (5 Mg) Tablets Marketed in Abuja Metropolis of Nigeria

“…Its IUPAC name is disodium [2-(8S, 9S, 10R, 11S, 13S, 14S, 17R)-11,17-dihydroxy-10, 13-dimethyl-3oxo- 7, 8, 9, 11, 12, 14, 15, 16-octahydro-6H-cyclopenta[α] phenanthren-17-yl]-2-oxoethyl phosphate, with C 21 H 28 O 5 as its molecular formula, while its molecular weight is 360.45. The therapeutic indications for prednisolone include endocrine, rheumatic, dermatologic, ophthalmic, respiratory, hematologic, neoplastic, gastrointestinal, and nervous system disorders, allergic conditions, edematous states, tuberculous meningitis, trichinosis, and as a substance of abuse for weight gain due to fluid retention side effects (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27).…”