Corticosteroids have been used in the treatment of croup for many years, but their usage has remained controversial. Early studies were often not blinded or used outcomes, such as respiratory rate, that we now know are inappropriate. Two attempts to review the available literature in 1980 and 1989 cautiously supported the use of corticosteroids. Despite these recommendations, many practitioners have taken the view that croup is in most cases a benign self-limiting condition of childhood, and that as corticosteroids have potential adverse effects their use was not justified.
More recently, however, a number of developments have reinforced the argument for using corticosteroids in the treatment of croup. Three reports of the successful use of the inhaled corticosteroid budesonide have added another aspect to management of croup, since much lower doses of inhaled corticosteroids may be used. Other recent work has shown that both inhaled and systemic corticosteroids take effect within 1 hour of administration, dramatically reducing morbidity and significantly reducing hospitalisation time. The demonstration that a dexamethasone dose of 0.15 mg/kg is as effective as 0.3 or 0.6 mg/kg will also make dexamethasone more acceptable to some practitioners.
Within our institution over the last 6 years the increasing use of corticosteroids in the management of croup has coincided with a dramatic reduction in the number of children who require intensive care and who need intubation. All children with croup considered severe enough to be admitted to hospital should receive corticosteroids. The type of corticosteroid, the dose and mode of administration will need to be decided by the attending clinician.
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Geelhoed, G.C. Croup. Clin. Immunother. 5, 260–267 (1996). https://doi.org/10.1007/BF03259326
- Oral Dexamethasone
- Princess Margaret Hospital