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Glucocorticoids Effective in Moderately Severe Croup.

This study is an important addition to the now convincing body of literature showing that glucocorticoids are effective in treating children with mild, moderate, and severe croup. In this double-blind study, 144 children with moderately severe croup were given racepinephrine and then randomized to receive a single dose of either 4 mg of nebulized budesonide (a synthetic glucocorticoid); 0.6 mg/kg of intramuscular dexamethasone; or a placebo. Before treatment, the three groups were similar in clinical severity, type of croup, and viral etiology. Treatment significantly reduced the need for hospitalization: 71 percent of children in the placebo group required hospitalization compared with 38 percent in the budesonide group and 23 percent in the dexamethasone group. Both treatment groups had significantly greater clinical improvement than did the placebo group, and when budesonide and dexamethasone were compared, dexamethasone was significantly more effective.

Comment: Having reviewed the literature, an editorialist reassuringly concludes that a single dose of systemic glucocorticoids or nebulized budesonide (not yet available in the U.S.) is safe. Children with croup should be treated with a glucocorticoid; oral dexamethasone is probably most convenient to use. Other ways of treating croup, such as humidification, should not be discarded.

— RA Dershewitz

Published in Journal Watch General Medicine September 1, 1998

Citation(s):

Johnson DW et al. A comparison of nebulized budesonide, intramuscular dexamethasone, and placebo for moderately severe croup. N Engl J Med 1998 Aug 20 339 498-503.

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• Medline abstract (Free)

Jaffe DM. The treatment of croup with glucocorticoids. N Engl J Med 1998 Aug 20 339 553-554.

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• Medline abstract (Free)