Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Management of croup in general practice: some questions
- Malcolm W Dyer (16 January 2000)
-
Glucocorticoids and croup: more issues
- John Sharvill (27 January 2000)
|
|
|||
|
Malcolm W Dyer
Send response to journal:
|
EDITOR - We have been following the recent correspondence concerning the management of children with Croup in General Practice. Whilst we do not currently use oral steroids for this indication, it is at least comforting that neither do the vast majority of our colleagues in General Practice(Tillet AJ, Gould JDM1). The letters have prompted us to draw up a practice protocol and in doing so raises several points. Firstly, Geelhoed et al.2 state an initial croup score in both arms of their double blind placebo study of 0.9. Whilst accepting that the score is a research tool for measurement rather than a clinically useful measure, it implies that all these children had very mild croup. Should we therefore be giving oral glucocorticoids to all children with a barking cough during the winter months? Secondly, whilst oral administration of steroids would appear to be the most acceptable and cost effective, is there likely to be any advantage of soluble prednisolone over betamethasone other than the issue of palatability, as suggested by Christopher Cates1, which is often of importance with younger patients? Thirdly, most GPs carry oral prednisolone because it is the only glucocorticoid mentioned for oral use in the Asthma Guidelines (BNF & BTS). If palatability is an issue, would the use of an equipotent dose of betamethasone be more appropriate than soluble prednisolone for children with acute severe asthma? Finally, it would seem reasonable to echo Dr. Cates’ view that the clear benefit of steroids in the emergency departments and admissions data examined by Ausejo’s meta-analysis3, should be mirrored in those patients who are treated in a primary care setting. More research is needed in this area. Malcolm W Dyer Donald Macaulay 1. Effectiveness of glucocorticoids in treating croup Terry P Klassen, Angela J Tillett, James D M Gould, Christopher Cates, S Jothimurugan, Zoaka Hassan, and M Silverman BMJ 1999; 319: 1577 2. Efficacy of a small single dose of oral dexamethasone for outpatient croup: a double blind placebo controlled clinical trial G C Geelhoed, J Turner, and W B G Macdonald BMJ 1996; 313: 140-142. 3. The effectiveness of glucocorticoids in treating croup: meta- analysis Monica Ausejo, Antonio Saenz, Ba' Pham, James D Kellner, David W Johnson, David Moher, and Terry P Klassen BMJ 1999; 319: 595-600. |
|||
|
|
|||
|
John Sharvill
Send response to journal:
|
Dear Sir, Several issues are raised by this weeks letters on the subject. None of the products mentioned, I believe, (dexamethasone, budesonide or betamethasone) have product licences for use in croup in children. EEC legislation makes the personal administration of a product without a data sheet except for single tablet/dose preparations legally awkward. How much discussion should take place with the parents before administration. At peak croup times (22.000 to 24.00) the on call doctor is usually quite busy with other calls waiting. Nevertheless I believe the vast majority of croup is still manged in primary care with reassurance, advice and time. In most instances croup prone children tend to have recurrent attacks over a few years (personal opinion with no evidence to back it up) and it seems that to make the parents feel that mild croup needs steroids is possibly a retrograde step. John Sharvill
|
|||