Alternative Treatments to Nebulized Epinephrine for Moderate Croup

Primary Treatment: Corticosteroids

• The European Respiratory Society recommends oral dexamethasone 0.6 mg/kg as the first-line choice for moderate croup, which is equally effective as intramuscular administration 2
• Nebulized budesonide 500 µg may reduce symptoms in croup within the first two hours, according to the Thorax journal 1, 3, 4, 5, 6
• Oral dexamethasone and nebulized corticosteroids are equally effective, as stated by the European Respiratory Society guidelines 2

Supportive Care Measures

• High flow humidified oxygen should be provided if there is evidence of respiratory distress, as recommended by the Thorax journal 1, 7
• Watch for signs of deterioration, including inability to talk or feed, respirations >50/min, pulse >140/min, or use of accessory muscles, as indicated by the Thorax journal 7