Tools for Practice Outils pour la pratique

#102 Coughing up the Data on Croup

Are glucocorticoids beneficial for mild to moderate croup and, if so, is lower dose equivalent to standard dose?

Glucocorticoids, including dexamethasone, are beneficial in the treatment of mild to moderate croup, with a NNT of 5 for symptom improvement and a NNT of 17 for return to care. Low-dose dexamethasone (0.15 mg/kg) may be equivalent to the more commonly prescribed 0.6 mg/kg. 

CFPCLearn Logo

Reading Tools for Practice Article can earn you MainPro+ Credits

La lecture d'articles d'outils de pratique peut vous permettre de gagner des crédits MainPro+

Join Now S’inscrire maintenant

Already a CFPCLearn Member? Log in

Déjà abonné à CMFCApprendre? Ouvrir une session

A systematic review (38 trials, 4,299 patients) evaluating glucocorticoids (the majority used dexamethasone) for mild to moderate croup found:1 
  • Significant improvement in croup symptoms at six hours: Number Needed to Treat (NNT) 5 (95% Confidence Interval 3 to 11). 
    • Similar improvement at 12 and 24 hours. 
  • Fewer return visits to emergency and/or (re)admissions: NNT 17 (13 to 28). 
  • Shorter time spent in emergency or hospital: mean difference 12 hours (5 to 19 hours). 
  • No reported adverse events. 
The above review included two small randomized controlled trials (137 patients with mild to moderate croup) that compared 0.15 mg/kg to 0.6 mg/kg of dexamethasone. There was no difference in: 
  • Change in croup score from baseline at six hours, Standard Mean Difference -0.02 (-0.37 to 0.32). 
  • Return visits and/or (re)admissions, Risk Ratio 1.04 (0.62 to 1.75).  
Limitations: small sample size.  Context:   
  • Even children with mild croup (croup score <2) benefit from glucocorticoid treatment.2 
  • Symptom improvement of steroids may be evident in ten minutes, with statistically significant improvement at 30 minutes.3 
  • A retrospective observational study found reduced hospital and intensive care admission rates, length of stay and intubations when 0.6 mg/kg dexamethasone was introduced and used in the hospital protocol (19801995).4 These rates did not change when 0.6mg/kg was replaced by 0.15 mg/kg in 1995.5  

Latest Tools for Practice
Derniers outils pour la pratique

#363 Making a difference in indifference? Medications for apathy in dementia

In patients with dementia, how safe and effective are stimulants, antidepressants, and antipsychotics for treating apathy?
Read Lire 0.25 credits available Crédits disponibles

#362 Facing the Evidence in Acne, Part I: Oral contraceptives and spironolactone in females

How effective are combined oral contraceptives (COC) and spironolactone for treating acne of at least mild-moderate severity in females?
Read Lire 0.25 credits available Crédits disponibles

#361 Preventing RSV Infections in Infants

How safe and effective are monoclonal antibodies to prevent respiratory syncytial virus (RSV) infections in infants?
Read Lire 0.25 credits available Crédits disponibles

This content is certified for MainPro+ Credits, log in to access

Ce contenu est certifié pour les crédits MainPro+, Ouvrir une session

  • Christina Korownyk MD CCFP
  • G. Michael Allan MD CCFP
  • Michael R Kolber BSc MD CCFP MSc
  • Ricky D. Turgeon BSc(Pharm) ACPR PharmD

1. Russell KF, Liang Y, O'Gorman K, et al. Cochrane Database Syst Rev. 2011; (1):CD001955.

2. Bjornson CL, Klassen TP, Williamson J, et al. N Engl J Med. 2004; 351(13):1306–13.

3. Dobrovoljac M, Geelhoed GC. Emerg Med Australas. 2012; 24(1):79–85.

4. Geelhoed GC. Ann Emerg Med. 1996; 28:621–6.

5. Dobrovoljac M, Geelhoed GC. Emerg Med Australas. 2009; 21(4):309–14.

Authors do not have any conflicts of interest to declare.