Croup medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Medical Therapy

The treatment of croup depends on the severity of symptoms.

One of the simplest ways to treat croup is to inhale hot steam. This was the sole treatment for croup throughout the nineteenth and most of the twentieth century. Hospitals today use a "blowby" apparatus for this purpose. Simpler remedies include taking the child outside in moist night air, or alternatively exposing the child to steam from a hot bath or a humidifier. These techniques may help in some cases, but there is little hard evidence to support their efficacy.

Mild croup with no stridor, or stridor only on agitation, and just a cough may simply be observed, or a dose of inhaled, oral, or injected steroids may be given. When steroids are given, dexamethasone is often used, due to its prolonged physiologic effects.

Moderate to severe croup may require nebulized adrenaline in addition to steroids. 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   ▸  Mist Therapy   ▸  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 of nebulized epinephrine for 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 Mist Therapy ▸ 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.

Croup Medical Therapy   ▸  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