Croup medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.

Overview

The treatment for croup depends on the severity of symptoms. The main stem for the treatment is the use of corticosteroids, especially dexamethasone or budesonide, given orally for mild cases and parenteral for more severe cases. Nebulized epinephrine is administered for moderate to severe cases, and it is effective in alleviating the intensity of symptoms related to upper airway obstruction, improvement is seen within 10-20 minutes since administration and last for approximately for 2 hours. There is no significant difference between using racemic and L-epinephrine, being the latter less expensive and available in most countries. Oxygen may be needed if hypoxia develops. Children with moderate or severe croup are typically hospitalized for observation, usually for less than a day. Intubation is rarely needed (less than 1% of hospitalized patients).

Medical Therapy Based on the MedicationAdapted from Lancet. 2008;371(9609):329–339.

▸ Click on the following categories to expand treatment regimens.

Croup Medical Therapy   ▸  Glucocorticoids   ▸  Epinephrine   ▸  Oxygen   ▸  Antibiotics   ▸  Heliox

Glucocorticoids Mild to Moderate Croup ▸ Dexamethasone 0.60 mg/kg PO/IM/IV, single dose (max. 10 mg) OR ▸ Budesonide 2mg nebulized Severe Croup ▸ Dexamethasone 0.60 mg/kg IM/IV, single dose OR ▸ Budesonide 2mg nebulized Epinephrine Mild Croup There are no indications for nebulized epinephrine in mild croup Moderate to Severe Croup ▸ Nebulized racemic epinephrine (2.25%) 0.05 mL/kg (max. 0.5mL) in 3mL of normal saline for 15 min OR ▸ Nebulized L-epinephrine 0.5mL/kg (max 5mL) for 15 min Repeat as needed Oxygen ▸ Humidified oxygen should be given to patients with hypoxia or severe respiratory distress Antibiotics ▸ Antibiotic are not indicated to treat viral croup ▸ Antibiotics are use for complications, such as bacterial tracheitis or epiglottitis Heliox ▸ There is no sufficient data that recommends the general use of heliox in patients with croup. ▸ Some studies have shown a short-term benefit of heliox inhalation in children with moderate to severe croup.

Medical Therapy Based on the Severity Adapted from Pediatric Pulmonology 49:421–429 (2014)

▸ Click on the following categories to expand treatment regimens.

Disease Severity   ▸  Mild   ▸  Moderate   ▸  Severe

Mild ▸ Dexamethasone 0.60 mg/kg PO single dose (max. 10 mg) OR ▸ Budesonide 2mg nebulized Moderate ▸ Nebulized racemic epinephrine (2.25%) 0.05 mL/kg (max. 0.5mL) in 3mL of normal saline for 15 min OR ▸ Nebulized L-epinephrine 0.5mL/kg (max 5mL) for 15 min Repeat as needed PLUS ▸ Dexamethasone 0.60 mg/kg PO/IM single dose (max. 10 mg) OR ▸ Budesonide 2mg nebulized Severe ▸ Nebulized racemic epinephrine (2.25%) 0.05 mL/kg (max. 0.5mL) in 3mL of normal saline for 15 min OR ▸ Nebulized L-epinephrine 0.5mL/kg (max 5mL) for 15 min Repeat as needed PLUS ▸ Dexamethasone 0.60 mg/kg IM/IV single dose (max. 10 mg) AND ▸ Hospital admission