Steroids for croup dosage

Figure 1 is an algorithm for outpatient management of croup based on illness severity. 25 – 34 Keeping a symptomatic child calm by avoiding distressing procedures is important because agitation may worsen airway obstruction. Positioning the child so that he or she is comfortable is appropriate because no particular position has been shown to be more beneficial in the assessment. Oxygen should be administered when the child is hypoxic or in severe respiratory distress. Heliox, a helium-oxygen mixture, has been used to reduce airflow resistance and turbulence. Although case reports have been encouraging, a systematic review found insufficient evidence that heliox is beneficial for croup. 35 Likewise, studies do not support the routine use of exposure to cold air, antipyretics, analgesics, antitussives, decongestants, or prophylactic antibiotics.

Additionally, the evidence does not support the notion that IM ketorolac is more effective than oral NSAIDs for pain relief in patients with acute renal colic. 44 , 45 Limited studies have shown that ketorolac is as effective as certain opioids for treating renal colic pain. 40 , 41 , 44 , 45 However, data also indicate that oral NSAIDs generally offer at least equal analgesia when compared with opioids. 40 , 44 , 45 No randomized, double-blind studies are available that directly compare oral NSAIDs with IM ketorolac. One study compared administration of a placebo injection to administration of a placebo oral agent and found that injections did not confer a selective placebo effect. 40

Since the 1970s, corticosteroid use for croup has been debated. A 1989 meta-analysis by Kairys 21 demonstrated benefit in the inpatient setting. More recently, results of a meta-analysis showed that treatment with glucocorticoids is effective in improving symptoms within six hours, for up to 12 hours, with significant improvement in croup scores, shorter hospital stays, and less use of epinephrine. 2 [Evidence level A: meta-analysis of randomized controlled trials (RCTs)] A Cochrane review of 24 studies involving more than 2,000 children concluded that treatment with corticosteroids reduces the Westley croup score at six hours. 22 [Evidence level A: meta-analysis of RCTs] However, most of the included studies took place in emergency departments or on the hospital floor after admission. While it seems clear that steroids provide benefit in the treatment of croup, more recent studies have tried to determine the optimal method of administration and the applicability of the treatment in the office setting.

A randomised, double-blind, placebo-controlled study compared the efficacy of Pulmicort Respules and placebo in the treatment of croup in 83 infants and children (aged 6 months to 8 years) admitted to hospital for croup. Patients received either Pulmicort Respules 2 mg or placebo every 12 h for a maximum of 36 h or until discharge from hospital. The total croup symptom score was assessed at 0, 2, 6, 12, 24, 36 and 48 hours after the initial dose. At 2 hours, both the Pulmicort Respules and placebo groups showed a similar improvement in croup symptom score, with no statistically significant difference between the groups. By 6 hours, the croup symptom score in the Pulmicort Respules group was statistically significantly improved compared with the placebo group, and this improvement versus placebo was similarly evident at 12 and 24 hours.

Steroids for croup dosage

steroids for croup dosage

A randomised, double-blind, placebo-controlled study compared the efficacy of Pulmicort Respules and placebo in the treatment of croup in 83 infants and children (aged 6 months to 8 years) admitted to hospital for croup. Patients received either Pulmicort Respules 2 mg or placebo every 12 h for a maximum of 36 h or until discharge from hospital. The total croup symptom score was assessed at 0, 2, 6, 12, 24, 36 and 48 hours after the initial dose. At 2 hours, both the Pulmicort Respules and placebo groups showed a similar improvement in croup symptom score, with no statistically significant difference between the groups. By 6 hours, the croup symptom score in the Pulmicort Respules group was statistically significantly improved compared with the placebo group, and this improvement versus placebo was similarly evident at 12 and 24 hours.

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