Glucocorticoids for Acute Laryngotracheitis in Children

Summary

A Cochrane review [Abstract] 1 included 45 studies with a total of 5 888 children aged up to 18 years. Twenty-six studies investigated any glucocorticoid comparedt to placebo. Of these, 15 investigated dexamethasone,4 investigated budesonide, 3 prednisolone, 1 fluticasone, and 3 both dexamethasone and budesonide. Four studies investigatedany glucocorticoid compared to epinephrine, and 13 studies investigated one glucocorticoid comparedto another glucocorticoid.

Compared to placebo, glucocorticoids improved symptoms of croup at 2 hours (SMD -0.65, 95% CI -1.13 to -0.18; statistical heterogeneity I²=81%; 7 studies, n=426), and the effect lasted for at least 24 hours (SMD -0.86, 95% CI -1.40 to -0.31; statistical heterogeneity I²=81%; 8 studies, n=351). Fewer return visits and/or (re)admissions occurred in patients treated with glucocorticoids (RR 0.52, 95% CI 0.36 to 0.75; statistical heterogeneity I²=52% 10 studies, n=1 679), and glucocorticoids reduced the length of stay in hospital by about 15 hours (MD -14.90, 95% CI -23.58 to -6.22; statistical heterogeneity I²=54% 8 studies, n=476). Serious adverse events were infrequent.

Dexamethasone seemed to reduce the return visits or (re)admissions for croup by almost half (RR 0.55, 95% CI 0.28 to 1.11; statistical heterogeneity I²=59%; 4 studies, n=1 537) compared to prednisolone, although the difference was not statistically significant, and showed a 28% reduction in the use of supplemental glucocorticoids as an additional treatment (RR 0.72, 95% CI 0.53 to 0.97; 2 studies, n=926).

Compared to 0.15 mg/kg, 0.60 mg/kg dexamethasone reduced the severity of croup at 24-hour (SMD 0.63, 95% CI 0.16 to 1.10; 1 study, n=72), but not at 2 hours (SMD −0.27, 95% CI −0.76 to 0.22; statistical heterogeneity I²=62%; 2 studies, n=861), at 6 hours (SMD −0.45, 95% CI −1.26 to 0.35; statistical heterogeneity I²=85%; 3 studies, n=178), and at 12 hours (SMD −0.60, 95% CI −4.39 to 3.19; statistical heterogeneity I²=98%; 2 studies, n=113). There was no difference between doses of dexamethasone in return visits or (re)admissions of children or both (RR 0.91, 95% CI 0.71 to 1.17; 3 studies, n=949) or length of stay in the hospital or emergency department (MD 0.12, 95% CI −0.32 to 0.56; 2 studies, n=892). The need for additional treatments, such as epinephrine, intubation or use of supplemental glucocorticoids did not differ between doses of dexamethasone.