Update on glucocorticoids for treatment of croup in children

Wednesday 15 February 2023

Vanessa Jordan

PEARLS No.

715

Clinical question

Are glucocorticoids effective and safe for treating croup in children aged 18 years and under?

Bottom line

Compared with placebo, budesonide and dexamethasone reduced the symptoms of croup within 2 hours of treatment, with the effect lasting at least 24 hours. One trial showed that prednisolone reduced the symptoms of croup within 6 hours, with the effect lasting at least 12 hours. One trial showed that fluticasone did not reduce the symptoms of croup after 2, 6 or 24 hours compared with placebo.

Compared with placebo, both budesonide and dexamethasone may have reduced the rate of return visits and/or (re)admissions to the hospital or emergency department.

Thirteen studies investigated one glucocorticoid compared with another glucocorticoid. Compared with budesonide, dexamethasone may have resulted in greater reductions in symptoms of croup after 6 and 12 hours, but there was probably no difference in the rate of return visits and/or (re)admissions.

There was little to no difference between dexamethasone and prednisolone for reduction in croup symptoms 2 hours following treatment, and likely no difference after 6 hours. However, dexamethasone probably reduced the rate of return visits and/or (re)admissions for croup by almost half.

Caveat

Most of the evidence presented in this review was graded as low. This was caused by 98% of the studies included having unclear or high risk of bias.

Adverse events were only measured in 53% of the included studies, and only 8 studies reported adverse events, which were mainly secondary bacterial infections (eg, pneumonia, sinusitis, otitis media).

Context

Respiratory viruses are the main cause of croup in children. Croup leads to a swelling of the throat and airway, which can make breathing difficult. Children also present with a special type of cough called a barking cough. Glucocorticoids are types of steroids that help reduce the swelling, thereby making it easier for children with croup to breathe. They are the mainstay for treatment of croup in children, but updating the evidence on their clinical relevance in croup is imperative.

Cochrane Systematic Review

Aregbesola A, et al. Glucocorticoids for croup in children. Cochrane Database Syst Rev 2023;1:CD001955. This review contains 45 trials with a total of 5888 participants.

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