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The use of adrenocorticoids to reduce the morbidity associated with laryngotracheitis (croup) remains controversial despite ten published reports of randomized trials involving 1,286 patients. To determine whether, viewed in aggregate, these studies demonstrate a significant benefit of steroid treatment for this disorder, a meta-analysis of the nine methodologically satisfactory trials was performed. Clinical improvement 12 and 24 hours posttreatment and incidence of endotracheal intubation were evaluated. For each end point, an estimate of the overall effect was obtained by calculating a typical odds ratio and 95% confidence interval. This analysis indicates that the use of steroids in children hospitalized with croup is associated with a significantly increased proportion of patients showing clinical improvement 12 hours (odds ratio = , 95% confidence interval = , ) and 24 hours (odds ratio = , 95% confidence interval = , ) posttreatment and a significantly reduced incidence of endotracheal intubation (odds ratio = , 95% confidence interval = , ). Higher initial doses of steroid (greater than or equal to 125 mg of cortisone or greater than or equal to 100 mg of hydrocortisone) were associated with a larger proportion of patients improved 12 hours posttreatment than was seen with lower doses. These results support the use of steroids in the treatment of hospitalized children with croup and, in the absence of a randomized clinical trial of sufficient size, provide the most reliable estimate of the impact of steroid therapy on the morbidity associated with croup. In addition, the results of this meta-analysis may be used to estimate the number of subjects who would be required to conduct a randomized clinical trial of steroids for the treatment of croup.

Michael H Augenbraun, MD, FACP  Professor of Medicine and Preventive Medicine and Community Health, Director of 3rd Year Medical Clerkship, State University of New York Downstate College of Medicine; Hospital Epidemiologist and Director, Department of Epidemiology, University Hospital of Brooklyn; Medical Director of Sexually Transmitted Diseases Clinic, Director of Lumbar Puncture Clinic, Kings County Hospital Center

Michael H Augenbraun, MD, FACP is a member of the following medical societies: American College of Physicians , Infectious Diseases Society of America

Disclosure: Nothing to disclose.

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To strengthen the anabolic properties of testosterone, more than 100 synthetic steroid derivatives have been described for human purposes. The anabolic effect promotes protein synthesis, muscle growth and erythropoiesis. In clinical practice, substances with anabolic effect are needed to overcome various catabolic states. However, none of these compounds are devoid of androgenicity. Androgenic and anabolic properties of anabolic steroids cannot be totally separated. Therefore, it is more appropriate to use the term anabolic androgenic steroids (AAS).

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To strengthen the anabolic properties of testosterone, more than 100 synthetic steroid derivatives have been described for human purposes. The anabolic effect promotes protein synthesis, muscle growth and erythropoiesis. In clinical practice, substances with anabolic effect are needed to overcome various catabolic states. However, none of these compounds are devoid of androgenicity. Androgenic and anabolic properties of anabolic steroids cannot be totally separated. Therefore, it is more appropriate to use the term anabolic androgenic steroids (AAS).

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