Croup

• Croup (laryngotracheitis) is a respiratory illness characterized by inspiratory stridor, barking cough, and hoarseness. 
• typically occurs in children six months to three years of age and is caused by parainfluenza virus

Glucocorticoids

• Glucocorticoids provide long-lasting and effective treatment of mild, moderate, and severe croup 
• The antiinflammatory actions of glucocorticoids are thought to decrease edema in the laryngeal mucosa of children with croup. 
• Improvement is usually evident within six hours of administration but seldom is dramatic

Dexamethasone

• Dexamethasone may be administered IM, IV, or orally. 
• no clinically significant difference in croup outcomes between IM or orally administered 
• When dexamethasone is administered IM or IV, a single dose of 0.6 mg/kg(maximum dose of 10 mg) is used most frequently

Budesonide

• Nebulized budesonide has been shown to be more effective than placebo and as effective as IM or oral dexamethasone for the treatment of croup 
• is more expensive and more difficult to administer than IM or oral dexamethasone and is not routinely indicated in the treatment of croup. 
• may provide an alternative to IM or IV dexamethasone for children with vomiting or severe respiratory distress
• In children with severe respiratory distress, a single dose of budesonide may be mixed with epinephrine and administered simultaneously

Prednisolone 

• Some authorities suggest that for children who are treated as outpatients, oral prednisolone (2 mg/kg per day for three days) is an alternative to oral dexamethasone 
• A RCT compared oral dexamethasone (0.6 mg/kg on the first day followed by placebo on the next two days) with oralprednisolone (2 mg/kg per day for three days) in 87 children with mild or moderate croup who were treated as outpatients showed no differences between groups in additional health care visit

Nebulized Epinephrine

• nebulized epinephrine to patients with moderate to severe croup often results in rapid improvement of upper airway obstruction. 
• Epinephrine constricts precapillary arterioles in the upper airway mucosa and decreases capillary hydrostatic pressure, leading to fluid resorption and improvement in airway edema 
• Even a modest increase in airway diameter can lead to significant clinical improvement
• Racemic epinephrine is administered as 0.05 mL/kg per dose (maximum of 0.5 mL) of a 2.25 percent solution diluted to 3 mL total volume with normal saline. It is given via nebulizer over 15 minutes
• clinical effects of nebulized epinephrine last for no more than two hours.

References:

1. www.uptodate.com
2. Paediatric Protocol 3rd Edition