What is the treatment for viral croup?

From the Guidelines

The treatment for viral croup typically involves the administration of corticosteroids, such as dexamethasone, at a dose of 0.6 mg/kg orally or intramuscularly, with a maximum dose of 10 mg 1.

Key Treatment Components

• Nebulized epinephrine may also be used in severe cases, at a dose of 0.5 mL of 1:1000 solution in 3 mL of saline, administered over 5-10 minutes.
• Symptomatic relief may be provided with acetaminophen or ibuprofen for fever and discomfort, at a dose of 10-15 mg/kg every 4-6 hours as needed.

Treatment Duration and Monitoring

Treatment duration is typically short-term, ranging from 24 to 48 hours, depending on the severity of symptoms. Monitoring patients in the emergency department for up to 2 hours after their second dose of racemic epinephrine (RE) can help determine if a third dose is needed and if admission is recommended 1.

Important Considerations

• A clinical guideline focusing on changing the number of RE doses prompting admission can lead to a significant reduction in hospital admissions for croup, with a relative decrease of 37% (95% CI: 8 to 66) 1.
• The use of a clinical guideline and orderset can also reduce the utilization of neck radiographs among patients presenting to the emergency department 1.

From the Research

Treatment Options for Viral Croup

The treatment for viral croup typically involves a combination of therapeutic modalities, including:

• Humidified air: Maintaining at least 50% relative humidity in the child's room is recommended 2
• Racemic epinephrine: Administered by nebulizer to quickly reverse airway obstruction in children with croup 2, 3
• Adrenal corticosteroids: The mainstay of treatment for severe croup, with dexamethasone being the most commonly used steroid 2, 4, 5, 6

Corticosteroid Treatment

Corticosteroids have been shown to be effective in reducing the symptoms of croup, with their benefits outweighing the risks 4. The recommended dosage of dexamethasone varies, but common dosages include:

• 0.6 mg/kg for moderate to severe croup 2, 5
• 0.15 mg/kg for mild croup 4, 6
• Nebulized budesonide (2 mg) can be used as an alternative to oral dexamethasone 4, 6

Additional Treatment Considerations

Other treatment considerations for viral croup include:

• Monitoring for rebound airway obstruction after administration of racemic epinephrine 2
• Use of supplemental oxygen in cases of hypoxemia 2
• Breathing heliox to potentially reduce the work of breathing related to upper airway obstruction 6