Availability of suitable formulations of oral glucocorticoids for croup.
This review suggests that glucocorticoids improve the course of croup
in children who are seen in emergency departments or admitted to hospital.
Many children with croup are not referred to hospital, so how are primary
care physicians to respond?
I see no reason to suppose that children with croup should NOT
benefit from steroids just because they are in the community, but
unfortunately dexamethasone is only available in tablet form in the
community in the UK. This is not a suitable formulation for small
Nebulised Budesonide is available but is expensive and inconvenient,
and the respules also go out of date alarmingly fast. As a result in our
practice we have adopted the policy of using soluble Betamethasone tablets
(Betnesol) which are equipotent to Dexamethasone and can be dissolved in a
drink. They also have the advantage of tasting more palatable than
soluble Prednisolone tablets (personal observation).
The paper which prompted our change in practice was published in the
BMJ in 1996 (1). We followed the example in that trial and have used a
single oral dose of 0.15mg/kg (prescribed as 500mcg Betnesol tablets to
dissolve in a drink) for children in the community with croup over the
past 2 years.
Others who decide that they wish to use oral steroids for children
with croup in the community may find this information on available
formulations useful, whilst we all wait for a much needed randomised
controlled trial of glucocorticoids in croup in primary care.
1. Geelhoed G, Turner J, Macdonald W. Efficacy of a small single
dose of oral dexamethasone for outpatient croup: a double blind placebo
controlled clinical trial. BMJ 1996;313:140-2
I have no financial interest in any of the above products which might
be used in the treatment of croup.
Competing interests: No competing interests