From the Research
Oral dexamethasone is recommended for outpatient management of mild to moderate croup at a single dose of 0.6 mg/kg (maximum 8 mg) as shown in the study by 1. This medication can be given as a liquid or tablet form, with the liquid formulation being preferred for younger children. The effects typically begin within 2-3 hours and last for approximately 72 hours, which usually covers the duration of most croup episodes. No taper is needed as a single dose is generally sufficient. Parents should be advised that symptoms may temporarily worsen before improving, and they should seek immediate medical attention if the child develops increased work of breathing, stridor at rest, or inability to drink fluids. Dexamethasone works by reducing airway inflammation and edema in the larynx and trachea, which helps decrease the characteristic barky cough and stridor associated with croup. Some key points to consider when treating croup with oral dexamethasone include:
- The dose of 0.6 mg/kg (maximum 8 mg) is supported by the study 1
- The use of oral dexamethasone has been shown to reduce return visits to healthcare facilities and hospitalization rates 1
- Supportive care with humidified air and keeping the child calm are also important adjunctive measures It's worth noting that while other studies such as 2 suggest a lower dose of 0.15 mg/kg, the study by 1 provides more recent and higher quality evidence for the use of oral dexamethasone in outpatient management of croup. Additionally, other treatment options such as racemic epinephrine and inhaled beclomethasone dipropionate may be considered in certain cases, but oral dexamethasone remains a recommended first-line treatment for mild to moderate croup 3.