The type of oral corticosteroid — prednisolone or dexamethasone — used to treat pediatric patients with croup appears to have no clinically significant effect on efficacy, both acutely and during the week following administration of the agent, according to study results published in the journal Pediatrics.

Researchers conducted a prospective, double-blind, noninferiority randomized, controlled trial at a tertiary pediatric emergency department and an urban district emergency department in Perth, Western Australia (Australian New Zealand Clinical Trials Registry Identifier: ACTRN 12609000290291).

Recognizing that the use of either prednisolone or low-dose dexamethasone in the treatment of childhood croup lacks a rigorous evidence base despite widespread use, the investigators sought to compare dexamethasone 0.6 mg/kg with both low-dose dexamethasone 0.15 mg/kg and prednisolone 1 mg/kg. Study inclusion criteria were age >6 months, maximum body weight 20 kg, the ability to be contacted by telephone, and having English-speaking caregivers. Study exclusion criteria included known dexamethasone or prednisolone allergy, immunosuppressive disease or treatment, use of corticosteroid therapy or enrollment in the same study within the prior 14 days, and a high clinical suspicion of an alternative diagnosis.

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A total of 1252 patients were enrolled in the study. Following exclusions, the 1231 remaining study participants were randomly assigned to treatment with dexamethasone at a dose of 0.6 mg/kg (n=410), low-dose dexamethasone (0.15 mg/kg; n=410), or prednisolone (n=411). The primary study outcomes were Westley Croup Score 1 hour following treatment and unscheduled medical reattendance during the 7 days following therapy.

The mean Westley Croup Score at baseline was 1.4 for dexamethasone (0.6 mg/kg), 1.5 for low-dose dexamethasone (0.15 mg/kg), and 1.5 for prednisolone (1 mg/kg). The adjusted difference in scores at 1 hour compared with dexamethasone (0.6 mg/kg) was 0.03 (95% CI, -0.09 to 0.15) for low-dose dexamethasone (0.15 mg/kg) and 0.05 (95% CI, -0.07 to 0.17) for prednisolone. In addition, reattendance rates were 17.8% for dexamethasone (0.6 mg/kg), 19.5% for low-dose dexamethasone (0.15 mg/kg), and 21.7% for prednisolone (not significant, P =.59 and P =.19).

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The investigators concluded that although the type of oral steroid used does not appear to have any clinically significant effect on efficacy among children with croup, children who are treated with prednisolone are more likely to require additional doses of the medication to cover the duration of their illness.


Parker CM, Cooper MN. Prednisolone versus dexamethasone for croup: a randomized controlled trial. Pediatrics. 2019;144(3).