II. Indications
- Moderate Croup with 2-3 awakenings on prior night
- Strongly consider even in mild croup
III. Contraindications
- Exposure to Varicella Zoster within prior 3 weeks
- Varicella Virus Vaccine (Varivax) in prior 2 weeks
- Pre-existing Immunodeficiency
IV. Preparations
-
Dexamethasone
- Oral as effective as intramuscular
- Dose: Croup
- Severe croup: 0.6 mg/kg IM/IV/PO
- Lower dose appears as effective as 0.6 mg/kg for mild to moderate cases
- Mild croup: Consider 0.15 mg/kg orally
- Moderate croup: Consider 0.3 mg/kg orally
- Maximum dosage in children: 10 mg
- Dose: Asthma Exacerbation
- Dexamethasone 0.3 to 0.6 mg/kg/day up to 15 mg for 1-2 days
- Keeney (2014) Pediatrics 133(3): 493-9 [PubMed]
- Preparations
- Oral suspension only available as 0.5 mg/5 ml
- Requires considerable volume for dose
- Injection solution (Decadron 4 mg/ml)
- Oral tablets available at up to 4 mg
- Consider Crushing Tablets into Chocolate syrup or apple sauce
- Oral suspension only available as 0.5 mg/5 ml
-
Nebulized Budesonide (Pulmicort)
- Pulmicort Nebule Dose
- Age <8 years old: 2.5 mg/day divided twice daily (full 2.5 mg dose given in ED)
- Age >8 years old: 5 mg/day divided twice daily (full 5 mg dose given in ED)
- Indications: May have role in mild croup exacerbations
- Consider for child who is Vomiting the Dexamethasone
- Dexamethasone is preferred
- Appears comparable to low dose Dexamethasone (0.15)
- Not as effective as high dose Dexamethasone (0.6 mg)
- Much more expensive than Dexamethasone
- Pulmicort Nebule Dose
V. Efficacy: Dexamethasone in Croup
- Clinical improvement
- Improvement onset in 6 hours
- Improvement continues at least 12-24 hours and may last 60-72 hours
- Decreases need for intubation by 80%
VI. Adverse Effects: Dexamethasone in Croup
- Increased appetite
- Increased aggressiveness