Croup Treatment

Treatment

Pharmacotherapy

Epinephrine (Nebulized)

Should be given to patients with severe respiratory distress
Reduces symptoms within minutes but exerts no effect beyond 1 hour
Hold discharge & observe patient for at least 2 hours after administration of Epinephrine
Combination with oral Dexamethasone is indicated for moderate to severe croup

Corticosteroid (Systemic)

Eg Dexamethasone, Prednisolone
Should be given to children diagnosed with croup regardless of severity
Improves symptoms & reduces risk of hospital admission
Well-absorbed, relatively safe
Multiple doses do not provide additional benefit over a single dose
Should not be given to a child w/ known immune deficiency or recent varicella exposure

Dexamethasone

Recommended first-line corticosteroid therapy for croup due to its long half-life and route options
May reduce return visit, hospital admission and readmission rates

Corticosteroid (Nebulized)

Eg Budesonide
May be given to children diagnosed with croup who are intolerant to Dexamethasone
Administration may cause more agitation to the child
Not routinely given to a child due to its cost, length of administration and anxiety that it causes
- Indicated only in patients with persistent vomiting and with severe respiratory distress
- Budesonide may be mixed with Epinephrine and administered simultaneously

Non-Pharmacological Therapy

Parent/Guardian Reassurance

Actions that minimize anxiety are appropriate until the airway is secure
Child should be held & comforted
Avoid anxiety-provoking maneuvers (eg blood extraction, IV line placement, placing the child in a supine position or direct inspection of the oral cavity) until the airway is secure

Helium-Oxygen (Heliox) Inhalation

Further studies are needed to prove the use of heliox in patients with croup
May be useful in reducing resistance of airflow & turbulence, thereby decreasing the work during respiration

Oxygen Therapy

Provide supplemental O₂ if necessary, especially in hypoxemic patients with O₂ saturation of <92%

How to control asthma well: Experts’ perspectives

Pearl Toh, 21 Sep 2020

Early and sustained treatments with simplified regimen are the key to achieving good asthma control, said experts during a presentation at the ERS 2020 Congress.

Mepolizumab: Targeting eosinophils in severe asthma with precision medicine

Pearl Toh, 16 Sep 2020

Mepolizumab, a first-in-class anti-IL-5* antibody, effectively prevents asthma exacerbations in patients with severe eosinophilic asthma (SEA), according to a presentation at the ERS 2020 Congress.

Tackling multidrug-resistant gram-negative bacterial infections in critically ill patients: Challenging the standard approach

Dr. Asok Kurup, Dr. Kenneth Chan, 07 Dec 2020

The rising incidence of infections caused by multidrug-resistant (MDR) gram-negative bacteria has become a serious health threat and a major challenge for intensivists. Against a backdrop of high patient mortality and risk factors for infection in intensive care units (ICU), early adequate therapy is of paramount importance. At a recent Pfizer-sponsored symposium, Dr Asok Kurup, Infectious Disease Physician, Singapore presented the implications of MDR gram-negative infections in critically ill patients in Asia, while Dr Kenneth Chan, Respiratory Physician and Intensivist, Singapore highlighted the role of ceftazidime-avibactam (Zavicefta) and shared published real-world data on ceftazidime-avibactam.