Andere richtlijnen

Bij de richtlijnen van de NHLBI, NICE, AAP (NGC) werden geen richtlijnen gevonden over ‘croup’. Wel bestaat er een Noord Amerikaanse en Australische richtlijn: Guideline for the management and diagnosis of croup, van de Alberta Clinical Practice Guidelines, North America: Dexamethasone is indicated in all children diagnosed to have croup (including those with only a barky cough without any other signs of respiratory distress)

Improvement begins within 2 to 3 hours after administration, and persists for 24 to 48 hours after the administration of a single dose. Trials have shown clear benefit even in children with very mild symptoms presenting more than a day after start of croup symptoms. A potential exception is the rare child with a known immune deficiency or recent exposure to varicella.

Dexamethasone may be administered orally in all but those children with very severe croup. Oral dexamethasone (using a parenteral/ injectible preparation mixed with a flavoured syrup) is rapidly adsorbed with less than 5% of children vomiting the drug. Nebulized budesonide is not routinely indicated for the treatment of croup.

Potential exceptions include: 1) a child who has had persistent vomiting and 2) a child with severe respiratory distress; in these patients, budesonide may be mixed with epinephrine and administered simultaneously.

Nebulized budesonide is likely equivalent but definitely not superior to oral dexamethasone. Administration of a nebulized drug usually takes between 10 and 15 minutes to administer, and most commonly causes significantly more agitation than oral administration of a drug. Further, budesonide is substantially more expensive than dexamethasone. The dose of budesonide is 2mg. 0.5mg/ml is the appro­priate concentration.