Most published (and good randomized controlled trials) data support that dexamethasone and inhaled budesonide are equally efficacious in decreasing symptoms---(good reference: NEJM 1998; 339:498-503). There has never been an adequate trial using oral prednisolone/prednisone; traditionally, dexamethasone has been the agent of choice (esp. by ENT) for the study of inflammation of the upper airway, while prednisolone/prednisone has been the model agent for lower airway studies (ie--asthma). Having said that, dexamethasone tastes horrible unless flavored by a pharmacist and Prelone is readily available and fairly palatable, and I would venture to say I as well as other private practice docs have had just as good success with oral prednisolone. Dosing is a little confusing. Standard trials have used 0.6 mg/kg/dose dexamethasone, but two small recent trials (Ped. Pulmonology Dec 1995 and May 1997) showed 0.15 mg/kg just as effective. To extrapolate to prednisone, this would be 1.5-6 mg/kg/dose (since dexamethasone 10 times as potent as pred.). I just fudge it and do 2 mg/kg/dose just as I do with my asthma patients. It seems to work fine. Gregory Plemmons, MD Assistant Professor of Pediatrics Vanderbilt University Medical Center "Eric, Lisa and Jack" <> on 10/03/99 04:36:20 PM Please respond to "Eric, Lisa and Jack" <> To: "Pedtalk" <> cc: (bcc: Gregory Plemmons/VUMC/Vanderbilt) Subject: Re: outbreak of mild croup I can't quote references off the top of my head, but I'm pretty sure data does not support the use of the prednisolone/prednisone steroids over dexamethasone. As for nebulized steroids, you can order a nasal steroid (the pulmonologist around here likes nasolide) and have the parent administer it via the nebulizer. But, isn't it time steroids are approved for nebulizer use? Eric M. Goodman MSN CPNP ----- Original Message ----- From: Vicki L Soloniuk <> To: Pedtalk <> Sent: Sunday, October 03, 1999 11:00 AM Subject: Re: outbreak of mild croup > I use Prelone syrup (prednisolone 15 mg/5 ml) if they are that sick. I > tell the mom it tastes awful and to give it with something sweet. If > they are bad enough to be admitted, I will give the steroids IV and > sometimes I do use the racemic epi, too. I have also had some response > with nebulized steroids if you can convince the pharmacy to compound the > solution for you. I have them dissolve 1 mg triamcinolone/1 ml saline > and nebulize that. Some of the pharmacies will do it and some won't. > > Vicki > > Denis Vulic wrote: > > > > Now, we have a lot of children with croup. Are you using racemic > > epinephrin and /dexamethason po or something other? > > How give a infant dexamethason po? > > Denis > > Vulic,MD > > group. > group. > >