Current pharmacological options in the treatment of croup

Abstract

Croup is one of the most common respiratory illnesses seen in the acute paediatric setting. It can be a cause of acute stridor and/or respiratory distress in young children. Research has shown that therapy aimed at reducing symptoms and inflammation can reduce complications such as the need for intubation, hospitalisation and improve quality of life for parents and children. Corticosteroids are the primary treatment option that will accomplish both goals and can be used in out-patient and in-patient settings. Corticosteroids may be given orally, parenterally or in wet nebulised form; however, oral administration is the preferred route. Wet nebulised adrenaline (racaemic or l-adrenaline) is also an effective treatment for more severe cases of croup. Recent studies have shown that mist/humidified air provides no additional symptom improvement, nor does it alter the overall cause of the disease process. Currently, there is insufficient randomised controlled trial evidence to support the role of heliox in the short-term treatment of croup.

27 years of croup: An update highlighting the effectiveness of 0.15 mg/kg of dexamethasone

“…[2][3][4][5][6][7][8][9][10][11]15,21 There is general agreement that oral dexamethasone is the preferred drug of choice based on its efficacy, cost and ease of administration. 4,16,17,[21][22][23] The dosage generally recommended, however, remains at 0.6 mg/kg, although a number of review articles [16][17][18]23 mention a range of 0.15-0.6 mg/kg. Often these recommendations are qualified by the statement that only one centre has successfully used 0.15 mg/kg.…”

“…[9][10][11][12][13][14][15] Opinion has strongly favoured routine corticosteroid treatment in all children with croup requiring a visit to ED. 10,12,13,[16][17][18] Although a single dose of oral dexamethasone for mild croup has been shown to be effective, 12,13 some controversy remains over the use of steroids in patients presenting with mild croup, as there is often a feeling that croup is a benign self-limited condition and steroids have potential side-effects in big doses. The dose of steroids remains controversial, despite some evidence that 0.15 mg/kg of dexamethasone 19,20 is as effective as the often recommended dose of 0.6 mg/kg.…”

“…From the mid‐1990s, the effectiveness of steroids in outpatients has been proven as well 9–15 . Opinion has strongly favoured routine corticosteroid treatment in all children with croup requiring a visit to ED 10,12,13,16–18 …”

Comparison between single‐dose oral prednisolone and oral dexamethasone in the treatment of croup: A randomized, double‐blinded clinical trial

“…Trials comparing parenteral, oral and nebulized routes of steroid delivery in croup have demonstrated similar efficacy 12–14 . Single‐dose oral dexamethasone is most widely preferred because of its proven efficacy, low cost, ease of administration and patient acceptability 4,9 , 15,16 . Nebulized budesonide and intramuscular dexamethasone are alternatives in patients who do not tolerate the oral preparation.…”

Croup: diagnosis and treatment

“…It is not a definitive treatment, but may allow time for the basic pathology to resolve. Normal L-adrenalin is preferred to racemic adrenaline, since it is safe, cheap and easily available worldwide [29][30][31][32][33]. The association of a nebulised steroid (i.e.…”