From the Guidelines
Dextromethorphan is not recommended for treating croup in children. Croup is a viral respiratory infection characterized by a barking cough, hoarseness, and stridor, primarily affecting the larynx and trachea. The standard treatment for mild croup includes humidified air or cool mist, while moderate to severe cases may require oral or inhaled corticosteroids (such as dexamethasone 0.6 mg/kg, maximum 10 mg) and occasionally epinephrine nebulization (2.25% racemic epinephrine or 1:1000 L-epinephrine).
Key Points to Consider
- Dextromethorphan is a cough suppressant that works on the cough center in the brain, but it does not address the underlying inflammation and airway narrowing that causes croup symptoms.
- Suppressing the cough in croup could potentially be harmful as it may prevent clearing of secretions.
- According to the study by 1, preparations containing anti-histamine and dextromethorphan were associated with adverse events, and using OTC medications has to be balanced with adverse events, which includes reported death from toxicity in young children.
- The study by 1 suggests that honey may offer more relief for cough symptoms than no treatment, diphenhydramine, or placebo, but it is not better than dextromethorphan, however, this does not support the use of dextromethorphan in croup.
- If a child has croup symptoms, focus on keeping them calm, ensuring adequate hydration, using humidified air, and seeking medical attention if symptoms are moderate to severe or if there is any respiratory distress.
Management of Croup
- For children with croup, the management should focus on alleviating symptoms and addressing the underlying cause of the condition.
- The use of humidified air, cool mist, and oral or inhaled corticosteroids can help alleviate symptoms and reduce the need for hospitalization, as shown in the study by 1.
- It is essential to seek medical attention if symptoms are moderate to severe or if there is any respiratory distress, as delayed treatment can lead to increased morbidity and mortality.
From the Research
Relationship between Croup and Dextromethorphan
There is no direct evidence in the provided studies to suggest a relationship between croup and dextromethorphan (Dextromethorphan) 2, 3, 4, 5, 6.
Treatment of Croup
- The mainstay of treatment for croup is glucocorticoids, which have been shown to be effective in reducing symptoms and shortening hospital stays 5.
- Dexamethasone is a commonly used glucocorticoid for the treatment of croup, and its effectiveness has been demonstrated in several studies 2, 3, 4, 5, 6.
- Nebulized epinephrine may also be used in the treatment of croup, particularly in cases of moderate to severe croup 2, 3, 6.
- Heliox inhalation has been shown to have a short-term benefit in children with moderate to severe croup who have been administered oral or intramuscular dexamethasone 2.
Key Findings
- Glucocorticoids, such as dexamethasone, are effective in reducing symptoms of croup and shortening hospital stays 5.
- Prehospital administration of dexamethasone may result in less ED epinephrine use and reflect dexamethasone's positive influence on the severity and short-term persistence of croup symptoms 6.
- There is no direct evidence to suggest a relationship between croup and dextromethorphan (Dextromethorphan) 2, 3, 4, 5, 6.