Efficacy of a small single dose of oral dexamethasone for outpatient croup: a double blind placebo controlled clinical trial

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Abstract
Objective: To assess the efficacy of a single dose of oral dexamethasone 0.15 mg/kg in children with mild croup not admitted to hospital. Design: Double blind, randomised, placebo controlled clinical trial. Setting: The emergency department of a tertiary paediatric hospital. Subjects: 100 children aged 4-122 months presenting with mild croup. Intervention: A single oral dose of dexamethasone 0.15 mg/kg or placebo. Main outcome measure: Return to medical care with ongoing croup. Results: Baseline characteristics of the two treatment groups were similar. Eight children (all from the placebo group) returned to medical care with ongoing croup, one being admitted. There was no reported difference in duration of croup symptoms, duration of viral symptoms, or rate of return to medical care for other reasons. Conclusion: Oral dexamethasone in a dose of 0.15 mg/kg is effective in reducing return to medical care with ongoing croup in children with mild croup. The benefits of steroids for children admitted to hospital are now well estab- lished Most children with croup may be sent home, though up to one fifth may return with croup A small single dose of oral dexamethasone (0.15 mg/kg) dramatically reduces the chance of reattending All children presenting with croup should be considered for steroids