Summary
Croup is an acute clinical syndrome of childhood characterised by a barking cough, hoarse voice, stridor and a variable degree of respiratory distress. A metaanalysis and subsequent controlled trials clearly demonstrate that corticosteroids are efficacious in the management of croup, with their benefits conclusively outweighing their risks. In mild to moderate cases of croup either systemic or nebulised corticosteroids decrease symptoms and need for hospitalisation. Most reports use IM dexamethasone 0.6 mg/kg, although it is likely that dexamethasone 0.15 mg/kg has a similar effect. In controlled studies nebulised budesonide 2mg is superior to placebo, and appears to have equivalent efficacy to oral dexamethasone. The risk of a single or short course of systemic corticosteroids are minimal, the only potential significant adverse effect being increased risk of severe varicella infection. Short courses of nebulised budesonide have no major adverse effects, and thus are likely to cause fewer adverse effects than systemic corticosteroids, although this is as yet unproven. On the body of data published to date, either oral dexamethasone 0.15 mg/kg or nebulised budesonide 2mg are effective for mild to moderate croup. In severe croup requiring intubation, oral prednisolone 1 mg/kg every 12 hours decreases the duration of intubation and the need for re intubation. Unless there are clear contraindications, corticosteroids are the treatment of choice in mild, moderate and severe croup.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Denny FW, Murphy TF, Clyde Jr WA, et al. Croup: an 11-year study in a pediatric practice. Pediatrics 1983; 71: 871–6
Jacobs S, Shortland G, Warner J, et al. Validation of a croup score and its use in triaging children with croup. Anaesthesia 1994; 49: 903–6
Geelhoed GC. Group in hospitalised children: impact of steroids [abstract]. Am J Respir Crit Care Med 1996; 153: A497
Couriel J. Management of croup. Arch Dis Child 1988; 63: 1305–8
Bourchier D, Dawson KP, Fergusson DM. Humidification in viral croup: a controlled trial. Aust Paediatr J 1984; 20: 289–91
Taussig LM, Castro O, Beaudry PH, et al. Treatment of laryngotracheobronchitis (croup): use of intermittent positive pressure breathing and racemic adrenaline. Am J Dis Child 1975; 129:790–3
Barkin RM, editor. Pediatric emergency medicine: concepts and clinical practice. St Louis: Moseby Yearbook Inc, 1992: 1002
Kairys SW, Olmstead EM, O’Connor GT. Steroid treatment of laryngotracheitis: a meta-analysis of the evidence from randomised trials. Pediatrics 1989; 83: 683–93
Koren G, Frand M, Barzilay Z, et al. Corticosteroid treatment of laryngotracheitis vs spasmodic croup in children. Am J Dis Child 1983; 137:941–4
James J. Dexamethasone in croup. Am J Dis Child 1969; 117: 511–6
Skowron PN, Turner JAP, McNaughton GA. The use of corticosteroid (dexamethasone) in the treatment of acute laryngotracheitis. Can Med Assoc J 1966; 94: 528–31
Leipzig B, Oski FA. A prospective randomised study to determine the efficacy of steroids in the treatment of croup. J Pediatr 1979; 94: 194–6
Muhlendahl KE, Kahn D, Spoor HL, et al. Steroid treatment in pseudo-croup. Helv Paediatr Acta 1982; 37: 431–6
Eden A, Larkin VP. Corticosteroid treatment of croup. Pediatrics 1964; 33: 768–9
Eden A, Kaufman A, Yu R. Corticosteroid and croup. JAMA 1967; 200: 403–4
Sussman S, Grossman M, Magoffin MD, et al. Dexamethasone (16 alpha-methyl, 9 alpha-flouroprednisolone) in obstructive respiratory tract infection in children. Pediatrics 1964; 34: 851–5
Martensson B, Nilson G, Torbjar J. The effect of corticosteroids in the treatment of pseudo-croup. Acta Otolaryngol (Stockh) 1960; 158: 62–9
Super DM, Cartelli NA, Brooks LJ, et al. A prospective randomised double-blind study to evaluate the effect of dexamethasone in acute laryngotracheitis. J Pediatr 1989; 115: 323–9
Cruz MN, Stewart G, Rosenberg N. Use of dexamethasone in the outpatient management of acute laryngotracheitis. Pediatrics 1995; 96: 220–3
Geelhoed GC, Macdonald WBG. Oral dexamethasone in the treatment of croup: 0.15 mg/kg versus 0.3 mg/kg versus 0.6 mg/kg. Pediatr Pulmonol 1995; 20: 362–8
Geelhoed GC, Turner J, Macdonald WBG. Efficacy of small single dose of oral dexamethasone for outpatient croup: a double blind placebo controlled clinical trial. BMJ 1996; 313: 140–2
Freezer NJ, Butt W, Phelan P. Steroids in croup: do they increase the incidence of successful extubation. Anaesth Intensive Care 1990; 18:224–8
Tibballs J, Shann FA, Landau LI. Placebo-controlled trial of prednisolone in children intubated for croup. Lancet 1992; 340: 745–8
Wolthers OD, Pedersen S. Short term linear growth in asthmatic children during treatment with prednisolone. BMJ 1990; 301: 145–8
Zora JA, Zimmerman D, Carey TL, et al. Hypothalamic-pituitary-adrenal axis suppression after short term, high dose glucocorticoid therapy in children with asthma. J Allergy Clin Immunol 1986; 77: 9–13
Wolthers OD, Riis BJ, Pedersen S. Bone turnover in asthmatic children treated with oral prednisolone or inhaled budeson-ide. Pediatr Pulmonol 1993; 16: 341–6
Rooklin AR, Lampert SI, Jaeger EA, et al. Posterior subcapsular cataracts in steroid requiring asthmatic children. J Allergy Clin Immunol 1979; 63: 383–6
Dowell SF, Bresee JS. Severe varicella associated with steroid use. Pediatrics 1993; 92: 223–8
Jacobs MB. Local subcutaneous atrophy after corticosteroid injection. Postgrad Med 1986; 80: 159–60
Godfrey S, Konig P. Treatment of childhood asthma for 13 months and longer with beclomethasone dipropionate aerosol. Arch Dis Child 1974; 49: 591–6
Ilangovan P, Pedersen S, Godfrey S, et al. Treatment of severe steroid dependent pre-school asthma with nebulised budeson-ide solution. Arch Dis Child 1993; 68: 356–60
Loffert DT, Ikle D, Nelson HS. A comparison of commercial jet nebulizers. Chest 1994; 106: 1788–93
Lodrup Carlsen KC, Nikander K, Carlsen K-H. How much nebulised budesonide reaches infants and toddlers?. Arch Dis Child 1992; 67: 1077–9
Brogden RN, McTavish D. Budesonide: an updated review of its pharmacological properties and the therapeutic efficacy in asthma and rhinitis. Drugs 1992; 44: 375–407
Stoney PJ, Chakrabarti MK. Experience of pulse oximetry in children with croup. J Laryngol Otol 1991; 105: 295–8
Husby S, Agertoft L, Mortensen S, et al. Treatment of croup with nebulised steroid (budesonide): a double blind, placebo controlled study. Arch Dis Child 1993; 68: 352–5
Klassen TP, Feldman ME, Watters LK, et al. Nebulized budesonide for children with mild-to-moderate croup. N Engl J Med 1994; 331: 322–3
Fitzgerald D, Johnson M, McCrossin T, et al. Nebulised budesonide as efficacious as nebulised adrenaline in moderately severe croup [abstract]. J Paediatr Child Health 1995; 31: A7
Geelhoed GC, MacDonald WBG. Oral and inhaled steroids in croup: A randomised placebo controlled trial. Pediatr Pulmonol 1995; 20: 355–61
Klassen TP, Watters LK, Feldman ME, et al. The efficacy of nebulized budesonide in dexamethasone treated outpatients with croup. Pediatrics 1996; 97: 463–6
Westley CR, Cotton EK, Brooks JG. Nebulised racemic epinephrine by IPPB for the treatment of croup: a randomised double blind study. Am J Dis Child 1978; 132: 484–7
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Yates, R.W., Doull, I.J.M. A Risk-Benefit Assessment of Corticosteroids in the Management of Croup. Drug-Safety 16, 48–55 (1997). https://doi.org/10.2165/00002018-199716010-00003
Published:
Issue Date:
DOI: https://doi.org/10.2165/00002018-199716010-00003