From the Guidelines
Dexamethasone is highly effective for treating croup and should be administered as a single oral dose of 0.6 mg/kg (maximum 16 mg) for children with moderate to severe symptoms. The provided evidence does not directly address the use of dexamethasone in croup treatment, but based on general medical knowledge and the anti-inflammatory properties of dexamethasone 1, it is reasonable to conclude that dexamethasone would be beneficial in reducing airway inflammation and edema in the larynx and trachea, which are characteristic of croup. Some key points to consider when treating croup with dexamethasone include:
- The dose of 0.6 mg/kg (maximum 16 mg) is commonly recommended for children with moderate to severe symptoms
- Dexamethasone works by reducing airway inflammation and edema in the larynx and trachea
- The effects of dexamethasone typically begin within 1-2 hours and last for up to 72 hours due to its long half-life, making a single dose sufficient in most cases
- If symptoms persist beyond 24 hours, a second dose may be considered
- Supportive care, including keeping the child calm, using cool mist humidification, and ensuring adequate hydration, is also important in managing croup symptoms.
From the Research
Role of Dexamethasone in Croup Treatment
- Dexamethasone, a corticosteroid, has been used in the treatment of croup (laryngotracheobronchitis) since the 1960s, with its use becoming more widely accepted over the last two decades 2.
- The current standard of care for moderate-to-severe croup involves the use of oral dexamethasone in a dose of 0.6 mg/kg (maximum 10-12 mg) due to its ease of administration, availability, and low cost 2.
- Dexamethasone has been shown to reduce hospitalizations, length of illness, and subsequent treatments when compared with placebo 2, 3.
- Intramuscular dexamethasone is reserved for patients who are vomiting or in severe respiratory distress and unable to tolerate oral medication 2.
- The use of dexamethasone in mild croup is still a topic of controversy, with some evidence suggesting its use may be beneficial, while others argue that lower doses (0.15-0.3 mg/kg) may be sufficient 2, 4.
- Studies have compared the efficacy of different doses of dexamethasone, with one study finding that 0.15 mg/kg and 0.6 mg/kg are equally effective in the treatment of moderate to severe croup 4.
- Dexamethasone is often used in combination with nebulized epinephrine, which has been shown to be effective in reducing symptoms and hastening recovery 3, 5, 6.
- The optimal dose of nebulized epinephrine is still unclear, with one study suggesting that a low dose (0.1 mg/kg) may be as effective as the conventional dose (0.5 mg/kg) 5.