What is the dose of Dexamethasone (corticosteroid) for pediatric patients with acute laryngotracheitis (croup)?

From the Guidelines

The recommended dose of dexamethasone for children with croup is 0.5 mg/kg, as most published studies used this dose and found it effective in reducing symptoms. When considering the treatment of croup in children, it's essential to prioritize the most effective and safe dosage of dexamethasone.

• The mechanism of efficacy of dexamethasone is unknown but may be related to its anti-inflammatory properties that reduce pain and swelling 1.
• Most published studies used a dexamethasone dose of 0.5 mg/kg; however, lower doses may be equally effective 1.
• In one systematic review of randomized controlled trials, for example, doses ranged from 0.15 to 1.00 mg/kg, with a maximum dose range of 8 to 25 mg 1. This medication works by reducing inflammation in the upper airway, which helps alleviate the characteristic barking cough, stridor, and respiratory distress associated with croup.
• Dexamethasone is the preferred corticosteroid for croup due to its long duration of action, which typically covers the entire illness period.
• The onset of action is relatively quick, with improvement often seen within a few hours after administration. Parents should be advised that while dexamethasone effectively reduces symptoms, supportive care including adequate hydration and comfort measures remains important. If stridor persists at rest or respiratory distress worsens despite treatment, medical reassessment is necessary.

From the Research

Dexamethasone Dose for Children with Croup

• The optimal dose of dexamethasone for children with croup has been studied in several trials 2, 3, 4.
• A study published in 2012 found that an oral dose of 0.15 mg/kg dexamethasone offers benefit by 30 min, much earlier than the 4 h suggested by the Cochrane Collaboration 2.
• Another study published in 1995 compared the efficacy of oral dexamethasone doses of 0.15 mg/kg, 0.3 mg/kg, and 0.6 mg/kg, and found that 0.15 mg/kg is as effective as 0.3 or 0.6 mg/kg in relieving symptoms and results in a similar duration of hospitalization in children with croup 3.
• A randomized comparison of dexamethasone 0.15 mg/kg versus 0.6 mg/kg for the treatment of moderate to severe croup found that both doses are equally effective 4.
• The evidence suggests that a dose of 0.15 mg/kg dexamethasone is effective in treating croup in children, and may be a suitable alternative to higher doses 2, 3, 4.

Comparison of Dexamethasone Doses

• Studies have compared the efficacy of different dexamethasone doses, including 0.15 mg/kg, 0.3 mg/kg, and 0.6 mg/kg 3, 4.
• The results of these studies suggest that lower doses of dexamethasone, such as 0.15 mg/kg, may be as effective as higher doses in treating croup in children 2, 3, 4.

Clinical Guidelines

• Clinical guidelines for the treatment of croup in children recommend the use of corticosteroids, such as dexamethasone, as a first-line treatment 5.
• The optimal dose of dexamethasone for children with croup is not specified in these guidelines, but the evidence suggests that a dose of 0.15 mg/kg may be effective 2, 3, 4.