A comparison of nebulized budesonide, and intramuscular, and oral dexamethasone for treatment of croup

Objective: Croup or acute laryngotracheobronchitis is the most common cause of the upper airway obstruction. Cool mist, nebulized racemic epinephrine and steroids are commonly used for therapy. Although steroid treatment can be applied orally, in nebulized form, or parenterally, no study has compared these three regimens yet. In this study, the efficacy of nebulized budesonide, and oral and intramuscular dexamethasone are compared for treatment of croup. Study design: Sixty children aged 6-36 months were randomly allocated into four groups. The first three study groups (15 children in each) took nebulized budesonide, oral dexamethasone and intramuscular dexamethasone, respectively, in addition to salbutamol and other supportive measures and these were compared with the placebo group. All patients were evaluated with "Westley Croup Score" on admission to pediatric emergency department (0 h) and at 24, 48 and 72 h. Results: At the end of the study, the croup scores of all steroid treatment groups were significantly lower than the placebo group, but there was no statistical difference among them. Conclusions: Nebulized budesonide, oral and parenteral dexamethasone have the same effectiveness for treatment of croup and the choice depends on conditions of the patient and the physician. (C) 2003 Elsevier Ireland Ltd. All rights reserved.