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Dexamethasone Versus Prednisolone in the Management of Croup: A Network Meta-Analysis of the Literature
21 Pages Posted: 13 Jul 2020
More...Abstract
Background: Croup is a prevalent childhood condition affecting around 3% of children annually. Management remains a topic of debate among clinicians in terms of choice and dose of oral glucocorticoid. We set out to review the literature and perform an analysis to identify which, if any, oral glucocorticoid treatment produced better patient outcomes.
Methods: We re-analysed published data using network meta-analysis. A literature search was performed on PMC, Embase, Cochrane, Web of Science and Medline. We included randomised, controlled trials in children admitted with croup and managed with any of: oral 0.15 mg/kg dexamethasone, 0.6 mg/kg dexamethasone or 1 mg/kg prednisolone. Data were extracted from work published between 1995-present and analysed using the ‘netmeta’ package in R. Exclusions were made due to lack of comparable outcome, differing drug dose or route. We assessed the overall Relative Risk of patients re-presenting to medical care with croup after treatment.
Findings: Our search identified 1250 records. Of these, 12 studies (N =3159) met our criteria. No significant difference was found between treatments: 0.15 mg/kg dexamethasone (RR: 0.44 [CI-95%: 0.30;0.65]); 0.6 mg/kg dexamethasone (RR: 0.46 [CI-95%: 0.29;0.72]) and 1 mg/kg prednisolone (RR: 0.53 [CI-95%: 0.33;0.83]). P-score ranking showed a slight preference for 0.6 mg/kg dexamethasone (P-score 0.870). The study was moderately heterogeneous with I2=32.1% [CI: 0-65.7%].
Interpretation: All three treatments assessed reduce the risk of children re-presenting with croup; however, our analysis did not significantly favour one treatment in particular. This may have implications in clinical practice.
Funding: None.
Declaration of Interests: The authors declare no competing interests.
Keywords: croup; laryngotracheitis; dexamethasone; prednisolone; meta-analysis; network meta-analysis
Suggested Citation: Suggested Citation