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• Oral or inhaled corticosteroids for the treatment of croup?
  Federico Marchetti
  Published on: 9 January 2022

• Published on: 9 January 2022

  Oral or inhaled corticosteroids for the treatment of croup?

  • Federico Marchetti, Clinical paediatrician
  • Other Contributors:
    • Jenny Bua, Marzia Lazzerini

  Dear Editor,

  In his extensive guideline review of the glucocorticoid treatment in croup, in agreement with the conclusions of the Cochrane review (1), Baumer HJ (2) states that “in the absence of further evidence, the use of a single oral dose of dexamethasone, probably 600 µg/kg, should be preferred because of its safety, efficacy and cost-effectiveness”.

  We believe this statement is not correct becau...

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  Dear Editor,

  In his extensive guideline review of the glucocorticoid treatment in croup, in agreement with the conclusions of the Cochrane review (1), Baumer HJ (2) states that “in the absence of further evidence, the use of a single oral dose of dexamethasone, probably 600 µg/kg, should be preferred because of its safety, efficacy and cost-effectiveness”.

  We believe this statement is not correct because a difference should be made between cases of mild-moderate and severe croup. In fact, before high doses of dexamethasone are used extensively in children with mild- moderate croup, some relevant questions need to be addressed.

  Russel K (1) and Griffin S and colleagues (3) reviewed the data from several double-blind randomised clinical studies of inhaled budesonide in croup and found it to be significantly more effective than placebo. Several studies also show that nebulised budesonide, the effect of which starts within 30 minutes, and oral dexamethasone are equally effective (1,3). Given the evidence, it seems more cautious to choose inhaled rather than oral/injectable corticosteroids for mild-moderate croup treatment. Secondly it has been shown that a single low oral dose of dexamethasone (150 µg/kg), as suggested by the BNF for children (4), is equally effective in treating croup (5). This issue needs to be further addressed, given the potential adverse effects of high-dose dexamethasone in children.

  Other than the need for further randomised controlled trials comparing different dexamethasone doses, as suggest by Baumer JH (2), we think that it could be more relevant to conduct studies comparing inhaled versus oral corticosteroids for the treatment of mild-moderate croup, with regard to their clinical onset of action and security profile.

  References:

  1. Russell K, Wiebe N, Saenz A, et al. Glucocorticoids for croup. Cochrane Database Syst Rev 2004; Issue 1:CD001955

  2. Baumer HJ. Glucocorticoid treatment in croup. Arch Dis Child Educ Pract Ed 2006;91:ep58-ep60

  3. Griffin S, Ellis S, Fitzgerald-Baroon A, Rose J, Egger M. Nebulised steroid in the treatment of croup: a systematic review of randomised controlled trials. Br J Gen Pract 2000;50:135-41

  4. British National Formulary. BNF for children. London: BMJ Publishing, 2005:158

  5. Sparrow A, Geelhoed G. Prednisolone versus dexamethasone in croup: a randomised equivalence trial. Arch Dis Child 2006;91:580-83

  Federico Marchetti, clinical paediatrician, fedemarche@tin.it

  Jenny Bua, senior house officer in paediatrics

  Marzia Lazzerini, clinical paediatrician

  Department of Paediatrics
  Institute of Child Health
  Burlo Garofolo
  Trieste

  Via dell'Istria 65/1-34100 Trieste, Italy

  Competing interests: None declared

  Correspondence to: Federico Marchetti
  Tel: 39-040-3785.454
  Fax: 39-040-3785452
  E mail: fedemarche@tin.it

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  Conflict of Interest:
  None declared.

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