ALL STEROIDS ARE NOT CREATED EQUALLY

Steroids are effective in the management of both moderate and severe croup. Rates of hospitalisation as well as revisits are reduced. The article by Sparrow and Geelhoed from Perth reminds us that not all steroids are of equivalent potency – this may be because of different glucocorticoid or mineralocorticoid effects or biological half life. They conducted a randomised, double-blind trial in which 133 children received either a single dose of 15 mg/kg of dexamethasone or 1 mg/kg of prednisolone. The rate of revisit was substantially lower in the dexamethasone group (7% vs 29%). Since they used an “equivalent” dose of prednisolone, they speculate that the half life of drug (dexamethasone (36 to 72 hours) vs prednisolone (12 to 36 hours), likely affected the outcome. This certainly makes biological and clinical sense since croup is often a 2–3 day disease. In checking my handy 2005 BNF for Children (page 407) I found that the oral form of dexamethasone is available in the UK, unfortunately it is unavailable in Australia. The lesson taught by this nicely done …