A randomized comparison of dexamethasone 0.15 mg/kg versus 0.6 mg/kg for the treatment of moderate to severe croup

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Summary

Background

Although previous studies have shown that dexamethasone is useful in croup, the optimal dosage has not been clarified yet. The aim of this study was to investigate the effectiveness of dexamethasone 0.15 mg/kg single dose compared with the recommended dose of 0.6 mg/kg for treatment of hospitalized children with moderate to severe croup.

Method

Forty-one children aged 6 months to 5 years admitted from March 2001 to October 2003 at the pediatric ward of Hatyai Hospital with moderate to severe croup were recruited for the study. After random allocation, each child received a single intravenous injection of either dexamethasone 0.6 mg/kg (maximum dose 12 mg) or 0.15 mg/kg (maximum dose 3 mg). All children were given a single dose of epinephrine nebulization at the beginning of the study. The croup scores were measured at 0, 1, 2, 3, 4, 6, 8, 10 and 12 h after the dexamethasone injection.

Results

One hour following the injection, the mean croup scores were significantly reduced from baseline values in both groups (p < 0.01). There was no difference in the mean croup scores between the two groups at any time. Median times to croup scores equal or less than two in both high- and low-dose groups were 8 and 7.9 h, respectively. No patient required intubation or was removed from the study because of a rising croup score after enrollment. There was no significant adverse reaction from dexamethasone treatment in either group.

Conclusion

Dexamethasone 0.15 and 0.6 mg/kg are equally effective in the treatment of moderate to severe croup.

Introduction

Croup (acute laryngotracheobronchitis) is a common cause of upper airway obstruction. The annual incidence ranges from 1.5% to 6% in children younger than 6 years of age [1]. From 1.5% to 31% of affected children are admitted to hospital [2] and 1–5% of hospitalized children with croup require mechanical ventilation [3].

The benefit of dexamethasone for treatment of croup has been well established [4], [5], [6], [7]. However, although these studies have shown that dexamethasone is useful in croup, the optimal dosage has not yet been clarified. The earlier studies of dexamethasone treatment in croup mostly used a dose of 0.6 mg/kg [6] but the behavioral change was observed among croup patients during treatment with this recommended dose [7]. In a few studies, a smaller dose has shown efficacy superior to a placebo and no report of adverse events [8], [9]. In an outpatient setting, oral dexamethasone 0.15 mg/kg significantly reduced the number of re-attending children for medical care with ongoing croup [8]. In hospitalized children, dexamethasone 0.15 mg/kg was as effective as a dose of 0.3 mg/kg [9]. However, no previous study has compared the efficacy of dexamethasone between doses of 0.6 and 0.15 mg/kg. Therefore, the aim of this study was to investigate the effectiveness of dexamethasone 0.15 mg/kg single dose compared with the recommended dose of 0.6 mg/kg for treatment of hospitalized children with moderate to severe croup.

Section snippets

Study patients

Enrollment occurred from March 2001 to October 2003 at the pediatric ward of Hatyai Hospital in the southern part of Thailand. Children aged 6 months to 5 years were eligible if they were admitted with moderate to severe croup (defined as 4–7 points on the validated croup scoring system of Westley et al. [10] in Table 1). Exclusion criteria were history of contact with chicken pox within the preceding 3 weeks, history of congenital or acquired stridor, chronic pulmonary disease, asthma, severe

Results

During the study period, 47 patients were admitted and 41 met the inclusion criteria. The mean age of the studied patients was 17.2 months and 69% were male. Among the patients included in the randomization, 21 patients received 0.15 mg/kg and 20 patients received 0.6 mg/kg of dexamethasone. There were more males in the high dose dexamethasone group (Table 2). After 1 h of treatment, the mean croup scores in both groups were significantly reduced from baseline values (p < 0.01). At no time was there

Discussion

We conducted a randomized, controlled clinical trial in order to compare the efficacy of dexamethasone 0.6 mg/kg versus 0.15 mg/kg for treatment of hospitalized children with moderate to severe croup. We found no difference in the croup scores between the two groups at any time point. The onset of action of dexamethasone was rapid, within 1 h treatment, in both groups.

Geelhoed and Macdonald [9] also reported that the croup scores of patients treated with corticosteroids improved within an hour. In

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