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BET 4: PRED VERSUS DEX

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Report by: Lucinda C Winckworth, SpR Paediatrics

Search checked by: Arabella Simpkin, SHO Paediatrics

Institution: The Whittington Hospital NHS Trust, London, UK

Clinical scenario

A 3-year-old with croup presents to A&E with inspiratory stridor. You want to treat with a steroid, and know dexamethasone is commonly used. Having recently used prednisolone in asthma, you wonder if this would be as effective as dexamethasone?

Three-part question

In (children with mild or moderate croup) is a (single dose of oral prednisolone) as effective as dexamethasone in (reducing the symptoms and severity of croup)?

Search strategy

Embase and Ovid MEDLINE databases were checked in Jan 2011 using the following search strategy—(prednisolone.af OR prednisone.af) AND (dexamethasone.af OR oradexon.af) AND (croup.af OR laryngotracheitis.af OR laryngotracheobronchitis.af).

Outcome

Ninety-nine papers were found, of which two were relevant. Scanning the article references or searching the Cochrane database, Clinical Evidence and SUMsearch, found a recent Cochrane review that incorporated these two studies.

Comments

The symptoms of acute viral laryngotracheobronchitis (croup) result from inflammation and oedema in the respiratory tract. The annual incidence is 3%, peaking in children aged 6–36 months during winter months. Most children are safely managed at home, although potential exists for increasing respiratory compromise.

The anti-inflammatory properties of glucocorticoids reduce the symptoms …

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