How should croup be treated?
There is also evidence regarding the most effective steroid treatment for croup in children. Oral dexamethasone outperforms oral prednisolone. Both oral treatments outperform nebulised budesonide. The suspicion is that dexamethasone outperforms prednisolone because it is better tolerated. It’s difficult for a medication to be effective if it’s just been puked onto the floor.
If that’s all so well evidence-based, what’s the problem?
Let’s get on with giving them all dexamethasone 0.15mg/kg. The problem with this is that dexamethasone liquid has done itself out of a job.
Dexamethasone is given as a single dose in the vast majority of cases. The evidence shows that this works well, quickly (2) and with an effect which is sustained over several days. It is quite potent, so small doses are effective. These factors, combined with unpredictable demand and a relatively short shelf life make dexamethasone liquid something that doesn’t make business sense for pharmacies to stock.
I recently asked the Twitter community about what they had available and while many did have dexamethasone liquid, it certainly wasn’t routinely available. The question also sparked a smattering of stories from people who had been sent from place to place looking for one that had some dexamethasone available.