Effectiveness of oral or nebulized dexamethasone for children with mild croup

Objective: To assess the efficacy of oral dexamethasone or nebulized dexame thasone sodium phosphate in children with mild croup. Methods: Double-blind, placebo-controlled study of 264 children between 6 m onths and 6 years of age with symptoms of croup for fewer than 48 hours. Pa tients were excluded if they received racemic epinephrine or corticosteroid treatment. Other exclusion criteria included corticosteroid treatment duri ng the 14 days prior to enrollment or complicating medical condition. Subje cts randomly received oral dexamethasone (0.6 mg/kg), nebulized dexamethaso ne sodium phosphate (160 mug), or placebo. Telephone follow-up was obtained on days 1, 2, 3, 4, and 7. Main Outcome Measures: The primary outcome measure was treatment failure, d efined as receiving corticosteroid or racemic epinephrine treatment during the 7 days after enrollment in the study. Secondary outcome measures includ ed seeking additional care and the parental assessments of the patients' co ndition obtained during follow-up (worse, same, better, or gone). Results: Eighty-five patients received oral dexamethasone, 91 received nebu lized dexamethasone, and 88 received placebo. There were 3 treatment failur es in the oral dexamethasone-treated group, 12 in the nebulized dexamethaso ne-treated group, and 10 in the placebo-treated group (P = .05). Ten childr en in the oral dexamethasone-treated group sought additional care compared with 27 and 29 in the nebulized dexamethasone-treated and placebo-treated g roups, respectively (P = .002). Parents of children in the oral dexamethaso ne-treated group reported greater improvement on day 1 (P < .001) compared with the nebulized dexamethasone-treated and placebo-treated groups. Conclusions: Children with mild croup who receive oral dexamethasone treatm ent are less likely to seek subsequent medical care and demonstrate more ra pid symptom resolution compared with children who receive nebulized dexamet hasone or placebo treatment.