What is the recommended dosage of dexamethasone (corticosteroid) for treating croup in children?

Dexamethasone Dosage for Croup in Children

The recommended dosage of dexamethasone for treating croup in children is 0.15 mg/kg as a single oral dose, which is as effective as higher doses while minimizing potential side effects. 1, 2, 3

Dosage Recommendations

• A single oral dose of dexamethasone at 0.15 mg/kg is as effective as higher doses (0.3 mg/kg or 0.6 mg/kg) in relieving symptoms and reducing hospitalization duration in children with croup 1
• Clinical benefits of dexamethasone at 0.15 mg/kg can be observed as early as 30 minutes after administration, much earlier than the previously suggested 4-hour timeframe 2
• For moderate to severe croup, both 0.15 mg/kg and 0.6 mg/kg doses of dexamethasone are equally effective in reducing croup scores 3

Administration Routes

• Oral administration is preferred for most cases of croup and is equally effective as parenteral routes 1, 2
• Intravenous administration may be considered for children with moderate to severe croup who cannot tolerate oral medication 3
• Maximum single dose should generally not exceed 10 mg 4

Clinical Considerations

• Dexamethasone is superior to prednisolone for croup treatment - children treated with prednisolone are more likely to require additional medical care (29% vs 7% with dexamethasone) 5
• For laryngotracheobronchitis (croup), nebulized epinephrine may be used in conjunction with dexamethasone for more severe cases: 0.5 mL/kg of 1:1000 solution (maximum: 5 mL) administered by nebulizer 6
• If racemic epinephrine is not available, L-epinephrine (1:1000) can be substituted at a dosage of 0.5 mL/kg up to 5 mL 6

Treatment Algorithm

1. Assess croup severity based on respiratory distress, stridor, and croup score

2. For mild to moderate croup:

   • Administer single oral dose of dexamethasone 0.15 mg/kg 1, 2
   • Monitor for improvement in symptoms within 30 minutes to 1 hour 2

3. For moderate to severe croup:

   • Administer single dose of dexamethasone 0.15 mg/kg (oral or IV if unable to take orally) 3
   • Consider nebulized epinephrine for significant respiratory distress 6
   • Hospitalize children requiring two or more epinephrine treatments 4

Important Caveats

• Dexamethasone should be given as early as possible in the course of illness for maximum benefit 2
• Antihistamines, decongestants, and antibiotics have no proven effect on uncomplicated viral croup and should be avoided 4
• Home care after treatment should focus on adequate hydration, humidification, and fever control 4
• While higher doses (0.6 mg/kg) have traditionally been recommended, the evidence supports using the lower dose of 0.15 mg/kg to minimize potential side effects while maintaining efficacy 1, 3