Nebulized Budesonide and Oral Dexamethasone for Treatment of Croup

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Abstract
Research from JAMA — Nebulized Budesonide and Oral Dexamethasone for Treatment of Croup — A Randomized Controlled Trial — Context.—The effectiveness of glucocorticoids for patients with croup is well established but it remains uncertain which glucocorticoid regimen is most effective.Objective.—To determine the effectiveness of 3 glucocorticoid regimens in patients with croup.Design.—Randomized controlled trial with parallel design.Setting.—Emergency departments of 2 Canadian pediatric tertiary care hospitals.Participants.—Children with a clinical syndrome consistent with croup, aged 3 months to 5 years, with a croup score of 2 or greater following at least 15 minutes of mist therapy.Interventions.—Oral dexamethasone, 0.6 mg/kg, and nebulized placebo; oral placebo and nebulized budesonide, 2 mg; or oral dexamethasone, 0.6 mg/kg, and nebulized budesonide, 2 mg.Main Outcome Measures.—Westley croup score (primary outcome), hospital admission rates, time spent in the emergency department, return visits to the emergency department, or ongoing symptoms at 1 week.Results.—The mean change in the croup score from baseline to the final study assessment was −2.3 (95% confidence interval [CI], −2.6 to −2.0) in the budesonide group (n=65), −2.4 (95% CI, −2.6 to −2.2) in the dexamethasone group (n=69), and −2.4 (95% CI, −2.7 to −2.1) in the budesonide and dexamethasone group (n=64, P=.70).Conclusions.—Based on the similar outcomes in the 3 groups, oral dexamethasone is the preferred intervention because of its ease of administration, lower cost, and more widespread availability.