Background In children with croup, treatment with nebulizedbudesonide decreases symptoms, but it is uncertain how budesonidecompares with dexamethasone, the conventional therapy for croup,and whether either reduces the rate of hospitalization.
Methods We performed a double-blind, randomized trial involving144 children with moderately severe croup. The children weretreated with racepinephrine and a single dose of 4 mg of nebulizedbudesonide (48 children), 0.6 mg of intramuscular dexamethasoneper kilogram of body weight (47 children), or placebo (49 children).The children were assessed before treatment and then hourlyfor five hours after treatment. Physicians who were unawareof the treatment assignments determined the children's needfor further treatment and hospitalization.
Results The characteristics of the groups were similar at baseline, including the types of viruses identified, the types ofcroup, and the clinical severity of the illness. The overallrates of hospitalization were 71 percent in the placebo group(35 of 49 children), 38 percent in the budesonide group (18of 48 children), and 23 percent in the dexamethasone group (11of 47 children) (unadjusted P=0.001 for the comparison of budesonidewith placebo, P<0.001 for the comparison of dexamethasonewith placebo, and P=0.18 for the comparison of budesonide withdexamethasone). Children treated with budesonide or dexamethasonehad a greater improvement in croup scores than those given placebo(P=0.03 and P<0.001, respectively), and those treated withdexamethasone had a greater improvement than those treated withbudesonide (P=0.003).
Conclusions In children with moderately severe croup, treatmentwith intramuscular dexamethasone or nebulized budesonide resultedin more rapid clinical improvement than did the administrationof placebo, with dexamethasone offering the greatest improvement.Treatment with either glucocorticoid resulted in fewer hospitalizations.
Source Information
From the Department of Paediatrics, University of Calgary, Alberta Children's Hospital, Calgary, Alta. (D.W.J., M.E.M.); the Department of Paediatrics, University of Toronto, Hospital for Sick Children, Toronto (S.J., P.H., S.S.); and Astra Pharma, Mississauga, Ont. (P.C.E.) — all in Canada.
Address reprint requests to Dr. Johnson at the Child Health Research Unit, Alberta Children's Hospital, 1820 Richmond Rd. SW, Calgary, AB T2T 5C7, Canada.
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