Comparison between single-dose oral prednisolone and oral dexamethasone in the treatment of croup: a randomized-controlled trial

Abstract

Introduction: Croup is a common respiratory illness in children, accounting for 15% of annual clinic and emergency department visits for pediatric respiratory tract infections. We aimed to compare single-dose oral prednisolone with single-dose oral dexamethasone in the treatment of croup in terms of mean change in the Westley Croup Score. Setting: Emergency Department of Children Hospital. Duration: Six months from December 2017 to June 2022. Design: Randomized-controlled trial. Subjects and methods: A total of 226 children with Westley Croup Score 2 or more were included in this study. Patients were randomized into two groups, 113 patients received a single dose of 0.15 mg/kg of oral dexamethasone, while 113 patients received a single dose of 1 mg/kg of oral prednisolone. Croup score and other clinical observations were repeated at 4 h and recorded in the questionnaire. Results: The average age of the patients was 2.88 ± 1.17 years. There were 129 (57.1%) males and 97 (42.9%) females. At 4 h, a significant reduction in mean Westley Croup Score was observed in group dexamethasone as compared with group prednisolone (P = 0.0005). Conclusions: Our trial demonstrated that oral dexamethasone at a dose of 0.15 mg/kg is effective in reducing the total croup score but there were no statistical differences in respiratory rate, pulse rate, and oxygen saturation between groups. Future studies are required to determine if these treatments differ in efficacy for severe croup and whether there is a role for multiple-dose corticosteroid therapy in some patients.