Effectiveness of Oral or Nebulized Dexamethasone for Children With Mild Croup

Luria, Joseph W.; Gonzalez-del-Rey, Javier; DiGiulio, Gregg A.; McAneney, Constance; Olson, Jennifer J.; Ruddy, Richard M.

doi:10.1001/archpedi.155.12.1340

Cited by 40 publications

(18 citation statements)

References 15 publications

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“…It is presumed that corticosteroids possess rapidly acting anti‐inflammatory or vasoconstrictive properties in the upper airway 8 , 14 , 19 . Studies using oral dexamethasone, 21 , 23 , 25 nebulised budesonide (2 mg/dose) 15 , 18 and nebulised dexamethasone 26 have demonstrated the efficacy of corticosteroids compared with placebo in relieving croup symptoms in the hospital setting. Commonly used alternatives to dexamethasone are prednisone or prednisolone 6 , 16 …”

Section: Evidence‐based Treatment Optionsmentioning

confidence: 99%

Croup: assessment and evidence‐based management

Fitzgerald

Kilham

2003

Medical Journal of Australia

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Croup affects about 2% of preschool‐aged children every year. Most children have mild croup and are managed at home, often after review by a general practitioner, who may decide that a single dose of oral corticosteroid is indicated (eg, if a risk factor for hospital admission exists). A minority of children develop moderate or severe croup. They should be reviewed in an emergency department and may need hospital admission. More liberal use of systemic corticosteroids for croup (in both primary care and emergency department settings) has been associated with reduced rates of hospital admission, reduced admissions to the intensive care unit and a reduced need for endotracheal intubation. We discuss the assessment and evidence‐based management of a child with mild croup presenting to a GP and a child with moderately severe croup presenting to an emergency department. We present a flow chart summarising an approach to assessing and treating croup in the emergency department.

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Section: Evidence‐based Treatment Optionsmentioning

confidence: 99%

Croup: assessment and evidence‐based management

Fitzgerald

Kilham

2003

Medical Journal of Australia

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“…8,9 Only two published trials have focused on corticosteroid treatment of mild croup. 10,11 One did not use clinical criteria to define mild croup clearly, 10 and the other included children with audible stridor at rest and indrawing of the chest wall, 11 symptoms that most health care professionals consider to represent more severe disease. The first study was small (100 patients) and assessed only one outcome: return to medical care for croup.…”

mentioning

confidence: 99%

A Randomized Trial of a Single Dose of Oral Dexamethasone for Mild Croup

Bjornson¹,

Klassen

Williamson³

et al. 2004

N Engl J Med

169

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“…They found that a single dose of oral dexamethasone (0.6 mg/kg/dose, maximum 20 mg) resulted in a significantly quicker resolution of symptoms and improvement in croup score compared to placebo [92]. Additional studies have consistently shown that GCs improve croup symptoms scores and reduce hospital admissions [57, 92–94]. In addition, a recent cochrane review of 38 RCTs, with a total of 4299 children pooled, further confirmed that GCs are effective in improving croup score symptoms and decreasing the number of return visits, (re)admissions, and hospital length of stay [57].…”

Section: Clinical Evidence Of the Use Of α-Ar Agonists And Gc In Tmentioning

confidence: 99%

“…Oral dexamethasone (0.6 mg/kg/dose) has been found to be as effective as intramuscular dexamethasone [94], and both are superior to nebulized dexamethasone in the treatment of mild and moderately severe croup in children [95]. Interestingly, high-dose nebulized budesonide (2–4 mg) seems to be equally effective as either oral or intramuscular dexamethasone in treatment of croup [96–98].…”

Section: Clinical Evidence Of the Use Of α-Ar Agonists And Gc In Tmentioning

confidence: 99%

Scientific Rationale for the Use of Alpha-Adrenergic Agonists and Glucocorticoids in the Therapy of Pediatric Stridor

Niño

Baloğlu

Gutiérrez

et al. 2011

International Journal of Otolaryngology

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Purpose. The most common pharmacological therapies used in the treatment of stridor in children are glucocorticosteroids (GC) and alpha-adrenergic (αAR) agonists. Despite the long-standing reported efficacy of these medications, there is a paucity of data relating to their actual mechanisms of action in the upper airway. Summary. There is compelling scientific evidence supporting the use of αAR-agonists and GCs in pediatric stridor. αAR signaling and GCs regulate the vasomotor tone in the upper airway mucosa. The latter translates into better airflow dynamics, as delineated by human and nonhuman upper airway physiological models. In turn, clinical trials have demonstrated that GCs and the nonselective αAR agonist, epinephrine, improve respiratory distress scores and reduce the need for further medical care in children with stridor. Future research is needed to investigate the role of selective αAR agonists and the potential synergism of GCs and αAR-signaling in the treatment of upper airway obstruction and stridor.

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Effectiveness of Oral or Nebulized Dexamethasone for Children With Mild Croup

Abstract: Children with mild croup who receive oral dexamethasone treatment are less likely to seek subsequent medical care and demonstrate more rapid symptom resolution compared with children who receive nebulized dexamethasone or placebo treatment.

Cited by 40 publications

References 15 publications

Croup: assessment and evidence‐based management

Croup: assessment and evidence‐based management

A Randomized Trial of a Single Dose of Oral Dexamethasone for Mild Croup

Scientific Rationale for the Use of Alpha-Adrenergic Agonists and Glucocorticoids in the Therapy of Pediatric Stridor

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