From the Guidelines
Croup treatment primarily involves managing symptoms and ensuring adequate oxygenation, with a single dose of oral dexamethasone (0.6 mg/kg, maximum 10 mg) being the cornerstone of treatment for moderate to severe cases, as evidenced by recent studies 1.
Treatment Approach
For mild croup, cool mist therapy and keeping the child calm can be effective.
- In moderate to severe cases, oral dexamethasone is the preferred treatment, reducing inflammation in the airway, with effects lasting several days 1.
- In severe cases with respiratory distress, nebulized epinephrine may be administered in a medical setting, providing temporary relief for 1-2 hours 1.
Key Considerations
- Children receiving epinephrine should be observed for at least 2-3 hours after treatment as symptoms may return 1.
- Supplemental oxygen should be provided if oxygen saturation falls below 92% 1.
Hospitalization Criteria
Most children with croup can be managed at home after treatment, but those with:
- Persistent stridor at rest
- Respiratory distress
- Oxygen requirements should be hospitalized 1.
Antibiotic Use
Antibiotics are not indicated as croup is typically viral, and their use is not supported by the evidence 1.
From the Research
Treatment Options for Croup
The treatment for croup (laryngotracheobronchitis) typically involves a combination of medications and supportive care. The primary treatment options include:
- Corticosteroids, such as prednisolone or dexamethasone, which can be given orally, intramuscularly, or intravenously 2, 3, 4, 5, 6
- Nebulized epinephrine, which can be used in severe cases of croup 2, 3, 4, 5, 6
- Supportive care, such as humidification, cool air exposure, and adequate hydration 5, 6
Medication Dosages
The dosages for these medications vary, but common dosages include:
- Prednisolone: 1.0 mg/kg orally 2
- Dexamethasone: 0.15 mg/kg to 0.6 mg/kg orally 3, 5
- Nebulized epinephrine: 0.5 mL of 2.25% solution diluted in 2.5 mL of saline solution 6
- Adrenaline: 4 mL of 1:1000 (undiluted) via nebuliser 2
Treatment Approaches
The approach to treatment depends on the severity of the croup. For mild to moderate croup, oral corticosteroids and supportive care may be sufficient 2, 5. For severe or life-threatening croup, nebulized epinephrine and hospitalization may be necessary 2, 3, 4, 5, 6.