ORIGINAL ARTICLE

Prednisolone versus dexamethasone in croup: a randomised equivalence trial

A Sparrow, G Geelhoed

Emergency Department, Princess Margaret Hospital for Children, Perth, Western Australia, Australia

Correspondence to:
Dr Gary Geelhoed
Emergency Department, Princess Margaret Hospital for Children, PO Box D184, Perth, Western Australia 6840; Gary.Geelhoed{at}health.wa.gov.au

Background: Croup remains a common respiratory problem presenting to emergency departments. A single oral treatment of oral dexamethasone results in improved outcome. Prednisolone has similar pharmacokinetic properties and has a significant advantage in that it is commercially available in liquid preparations.

Objective: To ascertain whether a single oral dose of prednisolone was equivalent to a single oral dose of dexamethasone (matched for potency) in children with mild to moderate croup.

Design: A double blind, randomised, controlled equivalence trial

Setting: Tertiary paediatric emergency department.

Patients: 133 children aged 3 to 142 months presenting with mild to moderate croup.

Interventions: Children received either a single oral dose of dexamethasone 0.15 mg/kg or single oral dose of prednisolone 1 mg/kg.

Outcome: The main outcome measure was unscheduled re-presentation to medical care as determined by telephone follow up at 7 to 10 days. Croup score, adrenaline (epinephrine) use, time spent in the emergency department, and duration of croup and viral symptoms were secondary outcome measures.

Results: Children treated with prednisolone were more likely to re-present: 19 of 65 children (29%) reattended medical care compared with 5 of 68 (7%) from the dexamethasone group. The confidence intervals around this 22% difference in outcome were 8% to 35%, outside the 0% to 7.5% range of equivalence. There were no significant differences in other outcome measures.

Conclusion: A single oral dose of prednisolone is less effective than a single oral dose of dexamethasone in reducing unscheduled re-presentation to medical care in children with mild to moderate croup.

Keywords: croup; dexamethasone; prednisolone

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