How fast does oral dexamethasone work in mild to moderately severe croup? A randomized double‐blinded clinical trial

Abstract

For children with croup an oral dose of 0.15 mg/kg dexamethasone offers benefit by 30 min, much earlier than the 4 h suggested by the Cochrane Collaboration. This result might encourage doctors to treat more children with all severities of croup being less worried about potential side-effects and delayed benefit.

Inpatient Treatment after Multi-Dose Racemic Epinephrine for Croup in the Emergency Department

“…ED observation periods of 2-6 h permit outpatient management of croup after single doses of RE in conjunction with systemic corticosteroids (7)(8)(9)(10)(11)(12). Although most studies demonstrate long-lasting reductions in croup severity score starting from 6 h after oral administration, corticosteroid effect can begin within 30 min (20,23). Although the median length of ED observation in our cohort was 2.8 h, median disposition decision time was only 6 min.…”

“…However, we retrospectively estimated croup severity using a clinical classification recommended by authorities in the assessment and management of croup (13,14,27,28). The Alberta croup score simplifies determination of severity according to the presence of stridor at rest and is comparable with stridor dimensions of the Westley and telephone outpatient scores used in prospective croup treatment studies (5,(21)(22)(23). Subsequent published adaptations reduce the score to three levels of severity based on stridor and retractions, and one published pathway uses only two levels of severity to guide treatment (14,17,18,28,29).…”

Parainfluenza Virus Type 1 Induces Epithelial IL-8 Production via p38-MAPK Signalling

“…HPIV-1 is responsible for almost half of all hospitalizations due to ARIs both in patients younger than 5 years old and in the elderly; additionally, HPIV-1 is the most common cause of infectious laryngotracheitis (croup) in children [3–6]. The therapy used to treat symptoms of inflammation is based on glucocorticoid and ephedrine, also humidifying the airway; however, this is not always effective [7–9]. The pathogenic mechanisms activated by HPIV-1 during infection are largely unknown.…”

Update on the utility of corticosteroids in acute pediatric respiratory disorders

“…36,39,40 The onset of action of dexamethasone may be clinically apparent as soon as 30 minutes after its administration. 41 In a patient who is not vomiting, there is little evidence to suggest that parenteral administration is superior to oral administration. 42 In children with mild-moderate croup seek-ing outpatient (but not ED care), oral treatment with prednisolone 2 mg/kg daily for three days and dexamethasone 0.6 mg/kg for 1 day followed by two days of placebo did not differ in terms of need for additional health care, or symptom reduction.…”