Which medications in the drug class Corticosteroids are used in the treatment of Croup?

Updated: Oct 09, 2019
  • Author: Germaine L Defendi, MD, MS, FAAP; Chief Editor: Russell W Steele, MD  more...
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Answer

Corticosteroids

Steroids are thought to decrease airway edema via their anti-inflammatory effect. Although a subject of controversy throughout the 1980s and 1990s, corticosteroids have since become a routine part of ED management of croup. Corticosteroids have been shown to reduce hospitalization rates by 86%, and in mild disease, they have been proven to reduce the number of children returning to the ED for further treatment.

In moderate to severe disease, corticosteroids improve croup scores within 12-24 hours and decrease hospitalization rates. Most trials have used dexamethasone at 0.6 mg/kg (intramuscular or oral), but oral doses as low as 0.15 mg/kg are effective. Oral and intramuscular routes appear equally beneficial. Prednisolone (1 mg/kg) has been proven effective but may be associated with a greater return of children to the ED.

Inhaled corticosteroids also have demonstrated efficacy, with most trials using budesonide. According to most authors, however, the relative ease, speed, and cost of administration make systemic corticosteroids preferable to nebulized formulations.

Dexamethasone (Baycadron)

Several studies have shown improvement in clinical symptoms and croup score in hospitalized and ED patients who received dexamethasone. The drug exerts a beneficial effect via anti-inflammatory action that decreases laryngeal mucosal edema. The onset of action occurs within 6 hours after oral or intramuscular administration. Dexamethasone has a long pharmacodynamic effect of 36-56 hours. No studies have evaluated the effect of multiple doses of the drug.

Prednisone

Several studies have shown improvement in clinical symptoms and croup score in patients who were treated while hospitalized or in the ED. Corticosteroids exert beneficial effect via anti-inflammatory action in which laryngeal mucosal edema is decreased. In calculating an appropriate prednisone dose, it is important to know that dexamethasone is 6.67 times more potent and has a long half-life of 36-56 hours, versus a median half-life of 18-36 hours for prednisone.

Prednisolone (Prelone, Pediapred, Millipred)

Corticosteroids exert beneficial effect via anti-inflammatory action in which laryngeal mucosal edema is decreased. Like with prednisone, in calculating an appropriate prednisolone dose, it is important to know that dexamethasone is 6.67 times more potent and has a long half-life of 36-56 hours, versus a median half-life of 18-36 hours for prednisolone.

Budesonide inhaled (Pulmicort Respules, Pulmicort Flexhaler)

Clinical studies have documented improvement in symptoms and decrease in hospital admissions with nebulized budesonide in children with croup. Inhaled budesonide has been shown in several studies to be equivalent to oral dexamethasone.

Corticosteroids exert beneficial effect via anti-inflammatory action in which laryngeal mucosal edema is decreased.


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