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Best evidence topic reports
Type of oral cortiosteroid in mild to moderate croup
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  1. A Corfield, Specialist Registrar,
  2. S Teece
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin.mackway-jones{at}man.ac.uk

    Abstract

    A short cut review was carried out to establish whether oral dexamethasone is better than oral prednisolone at improving outcome in children with mild to moderate croup. Altogether 139 papers were found using the reported search, of which none presented any evidence to answer the clinical question. It is concluded that there is no evidence available to answer this question. Further research is needed.

    http://dx.doi.org/10.1136/emj.20.3.264

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      Report by A Corfield,Specialist Registrar 
 Checked by S Teece, Clinical Research Fellow

      Clinical scenario

      A 3 year old boy arrives in the emergency department in the early hours of the morning. His mother reports that he has been unwell for 24 hours with a barking cough. On examination he is well and active but has stridor at rest. His temperature is normal, there is no indrawing and oxygen saturations are normal. You know that oral corticosteroids reduce the length of illness and need for hospital admission but wonder whether to use oral dexamethasone or oral prednisilone.

      Three part question

      In [patients with mild to moderate croup] is [oral dexamethasone better than oral prednisilone] at [improving outcome]?

      Search strategy

      Medline 1966–02/03 and EMBASE 1980–02/03 using the OVID interface. [exp prednisilone OR prednisilone$.mp OR exp prednisone OR prednidsone$.mp OR exp steroids OR steroid$.mp OR exp dexamethasone OR dexamethasone$.mp] AND [exp croup OR croup$.mp OR exp laryngotracheobronchitis OR laryngotracheobronchitis$.mp OR exp laryngotracheitis OR laryngotracheitis$.mp] LIMIT to human AND English.

      Search outcome

      Altogether 139 papers were identified. None answer the question.

      Comment(s)

      Croup is a common problem in the paediatric population. Oral corticosteroids are as effective as nebulised corticosteroids and are cheaper. Oral dexamethasone has an effective half life of 48 hours compared with 24 hours for prednisilone. Unfortunately there are no data directly comparing the efficacy of these two treatments.

      Clinical bottom line

      There is no evidence available to answer this question. Local advice should be followed.