# Acute croup (laryngotracheobronchitis) - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: WHO Pocket Book of Hospital Care for Children 2013 · Egyptian National Drug Formulary - Endocrine System 2024 (dexamethasone monograph) · Budesonide 0.5 mg nebuliser suspension SmPC section 4.2 (eMC product 100358) · Croup - disease-level clinical article (croup-full.txt) - Verified date: 2026-08 ## Verified against - Egyptian National Drug Formulary - Endocrine System 2024 (dexamethasone monograph) - Budesonide 0.5 mg nebuliser suspension SmPC section 4.2 (eMC product 100358) - Croup - disease-level clinical article (croup-clinical.txt) - Croup - disease-level clinical article (croup-full.txt) ## Treatment metadata - Dexamethasone — 0.5 mg — oral.liquid - Budesonide — 1 mg — oral.inhalation - Referral & safety-netting (no drug therapy) - Oxygen - Adrenaline — 1 mg — injection ## Complete treatment card ```text ACUTE CROUP (LARYNGOTRACHEOBRONCHITIS) Sources: WHO Pocket Book of Hospital Care for Children 2013 · Egyptian National Drug Formulary - Endocrine System 2024 (dexamethasone monograph) · Budesonide 0.5 mg nebuliser suspension SmPC section 4.2 (eMC product 100358) · Croup - disease-level clinical article (croup- full.txt) Review status: REVIEWED against Egyptian National Drug Formulary - Endocrine System 2024 (dexamethasone monograph), Budesonide 0.5 mg nebuliser suspension SmPC section 4.2 (eMC product 100358), Croup - disease-level clinical article (croup-clinical.txt), Croup - disease-level clinical article (croup-full.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (4) - One to two days of runny nose and low-grade fever precede a barking cough, without drooling or trouble swallowing [cough · fever · runny nose] - Seal-like barking cough, stridor, and hoarseness that worsen at night [cough · hoarseness · stridor] - Agitation worsens stridor, which can occur even at rest [irritability · stridor] - Illness typically lasts 3 to 7 days, peaking on day 3 or 4 SIGNS - what you find (3) - Nasal flaring, retractions, and rarely cyanosis suggest severe croup [chest recession · cyanosis] - Tachypnea and tachycardia may accompany croup [tachycardia · tachypnoea] - A Westley score over 5 warrants hospitalization; a score of 1 to 2 is safe for outpatient discharge TESTS (3) - Neck x-ray, when done, may show a steeple sign from tracheal narrowing - Blood tests are not routinely recommended since agitation can worsen airway swelling - Recurrent croup with a history of intubation in a young child warrants triple endoscopy IF NOT THIS - what else fits (7) - Epiglottitis lacks a barking cough and shows anxiety out of proportion to the distress - Children with epiglottitis sit upright in a tripod position and rarely cough - Bacterial tracheitis shows worsening croup symptoms with high fever and a toxic appearance - Deep neck space abscess presents with drooling, neck stiffness, and swollen lymph nodes rather than a barking cough - Foreign body aspiration causes sudden choking in a previously healthy child - Angioedema causes sudden lip and tongue swelling without preceding cold symptoms or fever - Structural airway anomalies cause chronic stridor without cold symptoms or fever Score Westley croup score - How severe is this croup? Source StatPearls "Croup" - disease-level clinical article Status traced to the source above Rx: Main treatment | Moderate-to-severe croup - nebulised, with dexamethasone MAIN TREATMENT - choose one, plus any add-on marked below 1. DEXAMETHASONE [1st line] Adult Not applicable — croup is an exclusively paediatric condition (see paediatric weight- based dosing) - Single dose Peds 0.15-0.6 mg/kg/dose [child max 12 mg] (0.15 mg/kg single oral dose (or 0.6 mg/kg in severe croup; max 12 mg)) 3kg -> 0.45-1.8 mg/dose 4kg -> 0.6-2.4 mg/dose 5kg -> 0.75-3 mg/dose 6kg -> 0.9-3.6 mg/dose 7kg -> 1.1-4.2 mg/dose 8kg -> 1.2-4.8 mg/dose 9kg -> 1.3-5.4 mg/dose 10kg -> 1.5-6 mg/dose 11kg -> 1.6-6.6 mg/dose 12kg -> 1.8-7.2 mg/dose 13kg -> 1.9-7.8 mg/dose 14kg -> 2.1-8.4 mg/dose 15kg -> 2.2-9 mg/dose 16kg -> 2.4-9.6 mg/dose 17kg -> 2.5-10.2 mg/dose 18kg -> 2.7-10.8 mg/dose 19kg -> 2.9-11.4 mg/dose 20kg -> 3-12 mg/dose 21kg -> 3.1-12 mg/dose (upper capped) 22kg -> 3.3-12 mg/dose (upper capped) 23kg -> 3.4-12 mg/dose (upper capped) 24kg -> 3.6-12 mg/dose (upper capped) 25kg -> 3.8-12 mg/dose (upper capped) 26kg -> 3.9-12 mg/dose (upper capped) 27kg -> 4-12 mg/dose (upper capped) 28kg -> 4.2-12 mg/dose (upper capped) 29kg -> 4.3-12 mg/dose (upper capped) 30kg -> 4.5-12 mg/dose (upper capped) 31kg -> 4.6-12 mg/dose (upper capped) 32kg -> 4.8-12 mg/dose (upper capped) 33kg -> 5-12 mg/dose (upper capped) 34kg -> 5.1-12 mg/dose (upper capped) 35kg -> 5.2-12 mg/dose (upper capped) 36kg -> 5.4-12 mg/dose (upper capped) 37kg -> 5.5-12 mg/dose (upper capped) 38kg -> 5.7-12 mg/dose (upper capped) 39kg -> 5.8-12 mg/dose (upper capped) 40kg -> 6-12 mg/dose (upper capped) 41kg -> 6.1-12 mg/dose (upper capped) 42kg -> 6.3-12 mg/dose (upper capped) 43kg -> 6.5-12 mg/dose (upper capped) 44kg -> 6.6-12 mg/dose (upper capped) 45kg -> 6.8-12 mg/dose (upper capped) 46kg -> 6.9-12 mg/dose (upper capped) 47kg -> 7-12 mg/dose (upper capped) 48kg -> 7.2-12 mg/dose (upper capped) 49kg -> 7.3-12 mg/dose (upper capped) 50kg -> 7.5-12 mg/dose (upper capped) Choice Alternatives. Single-dose oral dexamethasone is the standard of care; the entry keeps nebulised budesonide for the child who refuses or vomits the oral dose. Dexamethasone is also far cheaper (4-36 EGP against 106-529). Source Croup - disease-level clinical article (croup-full.txt): "Dexamethasone doses of 0.15, 0.3, or 0.6 mg/kg appear equally effective; 0.6 mg/kg is the most commonly used dose." The Egyptian formulary dexamethasone entry carries no croup indication and no paediatric mg/kg dosing. The 12 mg per-dose ceiling is not stated in this article. Why Single-dose oral corticosteroid dramatically reduces airway edema and hospital admission Caution Give single dose immediately upon presentation. Re-evaluate child within 1-2 hours; refer if stridor at rest persists. Caution in active varicella or systemic fungal infection. Egypt DEXAMETHASONE 0.1MG/ML SYP. 100 ML MEMPHIS 4.50 EGP -> ? strength differs DELTASONE 0.25MG/5ML SYRUP 120ML EL NILE. 30.00 EGP [? strength differs] ORAZONE 0.1MG/ML SYRUP 120ML ARAB DRUG COM... 36.00 EGP [? strength differs] 2. BUDESONIDE [1st line] Adult 2 mg single dose via jet nebulizer (alternative to oral dexamethasone) - Dosing can be repeated every 12 hour for a maximum of 36 hours or until clinical improvement. Peds 2 mg (=2000 mcg) single nebulized dose via face mask regardless of age/weight Source Budesonide 0.5 mg nebuliser suspension SmPC section 4.2 (eMC product 100358) Why Nebulized corticosteroid alternative when oral route is refused or vomited Caution Use jet nebulizer with face mask. Refer to hospital if respiratory distress, chest indrawing, or cyanosis present. Rinse mouth/face after nebulization if possible. 2 mg may be given as one dose or split into two 1 mg doses 30 minutes apart, and repeated every 12 hours for up to 36 hours or until the child improves. Egypt BUDELIZER 1 MG/2ML 20 SUSP. AMP. FOR INH. AMRIYA > EUROPEAN EGYPTIAN PHA... 106.50 EGP LUNGOCORT 1 MG/2ML 20 SUSP. AMP. FOR INH. EVA PHARMA 408.00 EGP BUDEXAN 1 MG/2ML 20 SUSP. AMP. FOR INH. GENETIC S.P.A > AMRIYA 529.00 EGP 3. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Croup - disease-level clinical article (croup-clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Parent and caregiver warning signs require immediate emergency evaluation. RED FLAG - Admission or extended observation is needed for severe croup or symptoms persisting after 2+ epinephrine doses. 4. OXYGEN [add-on - not a substitute] Adult Not applicable - croup is a paediatric condition (see paediatric dosing) Peds Any child whose oxygen saturation has fallen is given supplemental oxygen. The article states no flow rate and no target saturation. It does say how to give it: keep the delivery as undisturbing as it can be made, because agitating a child with croup worsens the obstruction, and holding the source near the face - blow-by - may work better than strapping on a mask or nasal cannula. Source Croup - disease-level clinical article (croup-full.txt) Why Severe croup is an airway emergency and the article gives oxygen to every child whose saturation has fallen. It states no flow rate and no target saturation, so the article's own wording is printed rather than a number invented for it. No Egyptian product corresponds to it, which the physician ruled acceptable on 2026-08-16. Caution Any agitation can worsen the symptoms - do not force a mask or nasal cannula on a distressed child; blow-by administration may be more effective. Oxygen treats the hypoxia, not the airway obstruction: a child in the moderate or severe range needs prompt treatment aimed at the obstruction itself - racemic epinephrine, a steroid, supportive care, and oxygen only as required. A child needing oxygen for croup needs hospital care - moderate-to-severe cases require observation and admission if the symptoms do not improve. MODERATE-TO-SEVERE CROUP - NEBULISED, WITH DEXAMETHASONE - give alongside 5. ADRENALINE [add-on - not a substitute] Adult Not applicable - croup is a paediatric condition (see paediatric dosing) Peds 0.5 mL/kg/dose (Approximately 0.5 mL/kg of L-epinephrine 1:1000 (the 1 mg/mL ampoule) by nebuliser, for moderate-to-severe croup. The article states no maximum volume and no maximum number of doses, so none is given here; do not invent one.) 3kg -> 1.5 mL/dose 4kg -> 2 mL/dose 5kg -> 2.5 mL/dose 6kg -> 3 mL/dose 7kg -> 3.5 mL/dose 8kg -> 4 mL/dose 9kg -> 4.5 mL/dose 10kg -> 5 mL/dose 11kg -> 5.5 mL/dose 12kg -> 6 mL/dose 13kg -> 6.5 mL/dose 14kg -> 7 mL/dose 15kg -> 7.5 mL/dose 16kg -> 8 mL/dose 17kg -> 8.5 mL/dose 18kg -> 9 mL/dose 19kg -> 9.5 mL/dose 20kg -> 10 mL/dose 21kg -> 10.5 mL/dose 22kg -> 11 mL/dose 23kg -> 11.5 mL/dose 24kg -> 12 mL/dose 25kg -> 12.5 mL/dose 26kg -> 13 mL/dose 27kg -> 13.5 mL/dose 28kg -> 14 mL/dose 29kg -> 14.5 mL/dose 30kg -> 15 mL/dose 31kg -> 15.5 mL/dose 32kg -> 16 mL/dose 33kg -> 16.5 mL/dose 34kg -> 17 mL/dose 35kg -> 17.5 mL/dose 36kg -> 18 mL/dose 37kg -> 18.5 mL/dose 38kg -> 19 mL/dose 39kg -> 19.5 mL/dose 40kg -> 20 mL/dose 41kg -> 20.5 mL/dose 42kg -> 21 mL/dose 43kg -> 21.5 mL/dose 44kg -> 22 mL/dose 45kg -> 22.5 mL/dose 46kg -> 23 mL/dose 47kg -> 23.5 mL/dose 48kg -> 24 mL/dose 49kg -> 24.5 mL/dose 50kg -> 25 mL/dose Source Croup - disease-level clinical article (croup-full.txt) Why The card carried dexamethasone, budesonide and oxygen but nothing for the child who is actually struggling. The condition's own article names the drug and gives the amount in the same document: a child with moderate or severe croup receives nebulised epinephrine alongside dexamethasone, and the amount is about 0.5 mL/kg by nebuliser, of the L- form at 1:1000 strength. At 2 hours it outperforms racemic epinephrine, because its effect lasts longer. Named Adrenaline because that is the Egyptian register's spelling; the 1 mg/mL ampoule is the 1:1000 solution the article specifies. Caution HOSPITAL OR OBSERVED SETTING ONLY. On the article's account, nebulised racemic epinephrine improves the symptom score within 30 minutes, but in moderate-to-severe croup the effect can fade by 2 hours, so the child must be watched for a prolonged period afterwards. Where the improvement holds, discharge home is possible after 4 hours of observation and instructions to follow up closely. A child nebulised and sent straight home can rebound. Given WITH dexamethasone, not instead of it - the article pairs them for moderate-to- severe croup. Keep the child calm - the article asks for the least invasive route of giving a drug in croup, because agitation of any kind makes the symptoms worse. (Croup - StatPearls - NCBI Bookshelf, NBK431070) The Egyptian formulary's adrenaline monograph covers anaphylaxis, shock, cardiopulmonary resuscitation and bradycardia, not nebulisation for croup, and it states positively that where the situation is life-threatening there is no absolute contraindication to giving epinephrine at all. The croup dose and route above come from the disease article, not from that monograph. Watch for tachycardia, tremor, pallor and hypertension after the dose. Egypt EPINEPHRINE-MEMPHIS 1 MG/ML 5 I.M./S.C. AMP. MEMPHIS 10.00 EGP ADRENAMAX 1 MG/1ML 10 AMPS. CHEMIPHARM 75.00 EGP EPINEPHRINE-MISR 1 MG/ML 100 AMP. MISR 750.00 EGP ADRENALINE-CID 1 MG/1ML 100 I.M./S.C. AMP. CID 850.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)