Efficacy of Oral Dexamethasone versus Parenteral Dexamethasone in the Management of Mild to Moderate Croup

Oral Dexamethasone versus Parenteral Dexamethasone

Abstract

Croup is a common cause of upper airway obstruction in children, characterized by a barking cough, stridor, and respiratory distress. While corticosteroids, particularly dexamethasone, are the cornerstone of treatment, the optimal, least invasive route remains debated, especially for mild-to-moderate cases. Objectives: To compare the efficacy of oral versus parenteral dexamethasone in children presenting with mild to moderate croup. Methods: This randomized controlled trial was conducted at the Department of Pediatrics, Khyber Teaching Hospital, Peshawar, from Oct 2024 to Mar 2025. A total of 200 children aged 6 months to 6 years with mild to moderate croup were randomized into two equal groups to receive a single dose of dexamethasone either orally (Group PO) or intramuscularly (Group IM) at 0.15 mg/kg. The primary outcome was improvement in the Westley Croup Score at 4, 8, and 24 hours. Secondary outcomes included respiratory rate, stridor, need for additional interventions, and parental satisfaction. Outcomes were compared between the groups using appropriate statistical tests, with a p-value of <0.05 considered significant. Results: The mean age was 23.5 ± 12.4 months. The Westley Croup Score and respiratory rate were significantly higher in Group PO at 4 hours (p=0.03), but comparable at 8 and 24 hours. No significant differences were noted regarding stridor or requirement for additional interventions. Parental satisfaction was significantly higher in Group PO (p=0.01). Conclusions: Oral dexamethasone is as effective and well-tolerated as intramuscular administration for mild to moderate croup in children under six years, with higher parental satisfaction.