From the Guidelines
Dexamethasone is the best oral steroid for treating croup. The management of croup, as outlined in the European Respiratory Journal, suggests that oral dexamethasone and nebulized corticosteroids are equally effective 1.
Key Points
- Dexamethasone has a longer duration of action, allowing for single-dose therapy in most cases.
- It has excellent bioavailability when given orally, making it convenient to administer.
- The medication typically begins working within 2-3 hours of administration, reducing inflammation in the upper airway and improving symptoms.
- A single dose of 0.6 mg/kg (maximum 16 mg) is typically sufficient, but occasionally a second dose may be needed if symptoms recur.
Administration and Effects
Dexamethasone works by reducing inflammation in the subglottic region, decreasing mucosal edema, and improving airflow, which in turn reduces the characteristic barking cough and stridor associated with croup 1.
Comparison with Other Options
While other corticosteroids like prednisolone could be considered, dexamethasone is preferred due to its longer duration of action and excellent bioavailability 1.
Special Considerations
If oral administration isn't possible, dexamethasone can also be given intramuscularly at the same dose, or nebulized epinephrine can be used as a temporary measure in more severe cases while waiting for the steroid to take effect.
From the Research
Oral Steroids for Croup
- The effectiveness of oral steroids for the treatment of croup has been supported by several studies 2, 3, 4, 5, 6.
- Dexamethasone is a commonly used oral steroid for croup, with studies comparing different dosages and administration methods 2, 3, 5, 6.
- A study comparing oral dexamethasone to intramuscular dexamethasone found no significant difference in the need for subsequent interventions after a single dose of either administration method 2.
- Another study found that dexamethasone 0.15 mg/kg and 0.6 mg/kg are equally effective in the treatment of moderate to severe croup 3.
- A community-based randomized trial compared the effectiveness of prednisolone and dexamethasone for children with croup, finding no differences in outcomes between the two treatments 4.
- The time to onset of action of oral dexamethasone has been studied, with one trial finding that 0.15 mg/kg dexamethasone offers benefit by 30 min, much earlier than previously suggested 5.
- A study comparing different dosages of oral dexamethasone 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 6.
Dosage and Administration
- The optimal dosage of dexamethasone for croup has not been fully clarified, with studies suggesting that 0.15 mg/kg may be as effective as 0.6 mg/kg 3, 5, 6.
- Oral dexamethasone can be effectively and safely used for the outpatient treatment of moderate croup, with a single dose of 0.6 mg/kg being a common regimen 2.
- The administration method of dexamethasone, whether oral or intramuscular, does not appear to affect the need for subsequent interventions 2.