What is the recommended dose of Decadron (dexamethasone) for croup in pediatric patients?

Recommended Dexamethasone Dosing for Pediatric Croup

For pediatric patients with croup, a single dose of dexamethasone 0.6 mg/kg (maximum 16 mg) administered orally, intramuscularly, or intravenously is recommended. 1

Dosing Options and Administration

• The standard recommended dose is 0.6 mg/kg (maximum 16 mg) administered orally, intramuscularly, or intravenously 1
• Lower doses of 0.15 mg/kg have been shown to be equally effective as 0.6 mg/kg for treating moderate to severe croup 2, 3
• Single-dose administration is sufficient and does not require tapering; it does not cause significant adrenal suppression 4
• Onset of action begins as early as 30 minutes after administration, even with the lower 0.15 mg/kg dose 5
• Clinical duration of action is approximately 24-72 hours 4

Clinical Considerations

• For moderate to severe croup with significant respiratory distress, consider combining dexamethasone with nebulized epinephrine 6
• Dexamethasone provides longer-lasting relief while epinephrine provides immediate but short-term symptom improvement 4
• For intubated patients, administer dexamethasone at least 6 hours before anticipated extubation to prevent upper airway obstruction 4

Evidence Quality and Comparative Efficacy

• Multiple randomized controlled trials have demonstrated that lower doses (0.15 mg/kg) are as effective as higher doses (0.6 mg/kg) in:
  • Reducing croup scores 2, 3
  • Decreasing duration of hospitalization 3
  • Preventing return visits for ongoing croup symptoms 7
• A 2012 study showed that the 0.15 mg/kg dose begins working within 30 minutes, much earlier than the previously suggested 4-hour onset 5

Common Pitfalls and Caveats

• Avoid using antihistamines, decongestants, or antibiotics for uncomplicated viral croup as they have no proven benefit 8
• When using nebulized epinephrine in conjunction with dexamethasone for severe cases, the recommended dose is 0.5 mL/kg of 1:1000 solution (maximum: 5 mL) 6
• Children requiring two epinephrine treatments should be hospitalized due to severity of symptoms 8
• While the American Academy of Pediatrics guidelines recommend 0.6 mg/kg, the evidence suggests that 0.15 mg/kg is equally effective with potentially fewer side effects 2, 3, 5