Farmacoriflessioni
La terapia del croup
THE TREATMENT OF CROUP
FEDERICO MARCHETTI, PATRIZIA SALIERNO
Clinica Pediatrica, Istituto per l’Infanzia, IRCCS “Burlo Garofolo”, Trieste
Aprile 2007 - pagg. 242 -248
Abstract
Viral croup is the most common cause of upper airway obstruction in children from 6 months to 6 years of age. Parainfluenza virus accounts for the majority of cases. More than 80% of children have mild symptoms and in approximately 60% to 95% of children, the symptoms disappear within 2 and 5 days, respectively. Based on the results of systematic review, glucocorticoid treatment was associated with an improvement in the Westley score at 6 hours and at 12 hours. Fewer return visits and/or (re)admissions occurred in patients treated with glucocorticoids (relative risk 0.50; 0.36 to 0.70). The setting, severity of croup, route of administration (oral or nebulised) and dose, and study quality, did not influence the effectiveness of treatment. Nebulised adrenaline should be reserved for patients with moderate to severe croup. Simultaneous administration of glucocorticoid and adrenaline reduces the rate of intubation in patients with severe croup. Mist/humidified air provides no additional symptom improvement.
Parole chiave
Suggerite dall'AI
IT
Croup
Classificazione MeSH
Bibliografia
1. Behrman RE, Kliegman RM, Jenson HB
(eds). Nelson Textbook of Paediatrics, 17° ed.
Philadelphia: WB Saunders, 2004.
2. Panizon F. Il crup. Medico e Bambino 2001; 20(1):46-8.
3. Amelia H, Thomas L, Richard S, et al. Changing Epidemiology of life-threatening upper airway infection: the re-emergence of bacterial tracheitis. Pediatrics 2006;118:1418-21.
4. Rafei K, Lichenstein R. Airway infections disease emergencies. Pediatr Clin North Am 2006;5382:215-42.
5. Loftis L. Acute infectious: upper airway obstructions in children. Semin Pediatr Infect Dis 2006;17:5-10.
6. Majumdar S, Bateman NJ, Bull PD. Paediatric stridor. Arch Dis Child Ed Pract 2006;91: ep101-ep105.
7. Denny FW, Murphy TF, Clyde WA, et al. Croup: an 11-year study in a pediatric practice. Pediatrics 1983;71:871-6.
8. Leung AKC, Kellner JD, Johnson DW. Viral croup: a current perspective. J Pediatr Health Care 2004;18:297-301.
9. Peltola V, Heikkinen T, Ruuskanen O. Clinical courses of croup caused by influenza and parainfluenza viruses. Pediatr Infect Dis J 2002;21(1):76-8.
10. Johnson DW, Williamson J. Croup duration of symptoms and impact on family functioning Pediatr Res 2001;49:83A.
11. Westley CR, Cotton EK, Brooks JG. Nebulized racemic epinephrine by IPPB for the treatment of croup: a double-blind study. Am J Dis Child 1978;132:484-87.
12. Robert BW, Brian HR, Robin JA. Current pharmacological options in the treatment of croup. Expert Opin Pharmacother 2005;6:255- 61.
13. Moore M, Little P. Humidified air inhalation for treating croup. Cochrane Database Syst Rev 2006;CD002870.
14. Scolnik D, Coates AL, Stephens D, Da Silva Z, Lavine E, Schuh S. Controlled delivery of high vs low humidity vs mist therapy for croup in emergency departments: a randomized controlled trial. JAMA 2006;295(11):1274- 80.
15. Radzik D. L’umidificazione non è un trattamento efficace nella laringite acuta. Medico e Bambino pagine elettroniche 2007;10(1); http://www.medicoebambino.com/index.php ?id=OAE0701_10.html
16. Kairys SW, Olmstead EM, O’Connor GT. Steroid treatment of laryngotracheitis: a metaanalysis of the evidence of randomised trials. Pediatrics 1989;83:683-93.
17. Russell K, Wiebe N, Saenz A, et al. Glucocorticoids for croup. Cochrane Database Syst Rev 2004; Issue 1:CD001955.
18. Baumer HJ. Glucocorticoid treatment in croup. Arch Dis Child Educ Pract Ed 2006;91: ep58-ep60.
19. Amir L, Hubermann H, Halevi A, Mor M, Mimouni M, Waisman Y. Oral betamethasone versus intramuscular dexamethasone for the treatment of mild to moderate viral croup: a prospective, randomized trial. Pediatr Emerg Care 2006;22(8):541-4.
20. Bjornoson CL, Klassen TP, Williamson J, et al. Treatment of mild croup with a single dose of oral dexamethasone: a multicenter, placebo-controlled trial. N Engl J Med 2004; 315: 1306-13.
21. Marchetti F, Longo G, Ventura A. Dexamethasone for mild croup. N Engl J Med 2004;351(26):2768-9.
22. British National Formulary. BNF for children. London: BMJ Publishing, 2005:158.
23. Geelhoed GC, Macdonald WB. Oral dexamethasone in the treatment of croup: 0.15 mg/kg versus 0.3 mg/kg versus 0.6 mg/kg. Pediatr Pulmonol 1995;20(6):362-8.
24. Sparrow A, Geelhoed G. Prednisolone versus dexamethasone in croup: a randomised equivalence trial. Arch Dis Child 2006;91:580- 8.
25. Geelhoed GC, Turner J, Macdonald WB. Efficacy of a small single dose of oral dexamethasone for outpatient croup: a double blind placebo controlled clinical trial. BMJ 1996;313(7050):140-2.
26. Canciani M, Longo G. Novità nella terapia del croup. Medico e Bambino 1995;14(3):128- 30.
27. Griffin S, Ellis S, Fitzgerald-Baroon A, Rose J, Egger M. Nebulised steroid in the treatment of croup: a systematic review of randomised controlled trials. Br J Gen Pract 2000; 50:135-41.
28. Roorda RJ, Walhof CM. Effects of inhaled fluticasone propionate administered with metered dose inhaler and spacer in mild to moderate croup: a negative preliminary report. Pediatr Pulmonol 1998;25:114-7.
29. Marchetti F, Bua J, Lazzerini M. Oral or inhaled corticosteroids for the treatment of croup? Arch Dis Child Ed Pract 2007;92:ep13.
30. Fitzgerald DA, Mellis CM, Johnson M, et al. Nebulized budesonide is as effective as nebulized adrenaline in moderately severe croup. Pediatrics 1996;97:722-25.
31. Roberts GW, Master VV, Staugas RE, et al. Repeated dose inhaled budesonide versus placebo in the treatment of croup. J Paediatr Child Health 1999;35:170-4.
32. Geelhoed GC. Budesonide offers no advantage when added to oral dexamethasone in the treatment of croup. Pediatr Emerg Care 2005;21(6):359-62.
33. Gardner HG, Powell KR, Roden VJ, et al. The evaluation of racemic epinhephrine in the treatment of infection croup. Pediatrics 1973; 52:52-5.
34. Taussig IM, Castro O, Beaudry PH, et al. Treatment of laryngotracheo-bronchiolitis (croup). Am J Dis Child 1978;132:484-7.
35. Fogel JM, Berg LJ, Gerber MA, et al. Racemic epinhephrine in the treatment of croup: nebulization alone versus nebulization with intermittent positive pressure breathing. J Pediatr 1982;101:1028-31.
36. Kuusela AL, Vesikari T. A randomized double- blind, placebo-controlled trial of dexamethasone and racemic epinephrine in the treatment of croup. Acta Paediatr Scand 1988; 77:99-104.
37. Kelley PB, Simon JE. Racemic epinephrine use in croup and disposition. Am J Emerg Med 1992;10:181-3.
38. Waisman Y, Klein BL, Boenning DA, et al. Prospective randomised double-blind study comparing L-epinephrine and racemic epinephrine aerosols in the treatment of laryngotracheitis (croup). Pediatrics 1992;89:302-6.
39. Martinez FA, Sanchez GE, Rica EI, et al. Randomized double-blind study of treatment of croup with adrenaline and/or dexamethasone in children. Anales Espanoles de Pediatria 1993;38:29-32.
40. Prendergast M, Jones JS, Hartman D. Racemic epinephrine in the treatment of laryngotracheitis: can we identify children for outpatient therapy? Am J Emerg Med 1994;12: 613-6.
41. Ledwith CA, Shea LM, Mauro RD. Safety and efficacy of nebulized racemic epinephrine in conjunction with oral dexamethasone and mist in the outpatient treatment of croup. Ann Emerg Med 1995;25:331-7.
42. Fitzgerald DA, Kilham HA. Croup: assessment and evidence-based management. MJA 2003;179(7):372-7.
2. Panizon F. Il crup. Medico e Bambino 2001; 20(1):46-8.
3. Amelia H, Thomas L, Richard S, et al. Changing Epidemiology of life-threatening upper airway infection: the re-emergence of bacterial tracheitis. Pediatrics 2006;118:1418-21.
4. Rafei K, Lichenstein R. Airway infections disease emergencies. Pediatr Clin North Am 2006;5382:215-42.
5. Loftis L. Acute infectious: upper airway obstructions in children. Semin Pediatr Infect Dis 2006;17:5-10.
6. Majumdar S, Bateman NJ, Bull PD. Paediatric stridor. Arch Dis Child Ed Pract 2006;91: ep101-ep105.
7. Denny FW, Murphy TF, Clyde WA, et al. Croup: an 11-year study in a pediatric practice. Pediatrics 1983;71:871-6.
8. Leung AKC, Kellner JD, Johnson DW. Viral croup: a current perspective. J Pediatr Health Care 2004;18:297-301.
9. Peltola V, Heikkinen T, Ruuskanen O. Clinical courses of croup caused by influenza and parainfluenza viruses. Pediatr Infect Dis J 2002;21(1):76-8.
10. Johnson DW, Williamson J. Croup duration of symptoms and impact on family functioning Pediatr Res 2001;49:83A.
11. Westley CR, Cotton EK, Brooks JG. Nebulized racemic epinephrine by IPPB for the treatment of croup: a double-blind study. Am J Dis Child 1978;132:484-87.
12. Robert BW, Brian HR, Robin JA. Current pharmacological options in the treatment of croup. Expert Opin Pharmacother 2005;6:255- 61.
13. Moore M, Little P. Humidified air inhalation for treating croup. Cochrane Database Syst Rev 2006;CD002870.
14. Scolnik D, Coates AL, Stephens D, Da Silva Z, Lavine E, Schuh S. Controlled delivery of high vs low humidity vs mist therapy for croup in emergency departments: a randomized controlled trial. JAMA 2006;295(11):1274- 80.
15. Radzik D. L’umidificazione non è un trattamento efficace nella laringite acuta. Medico e Bambino pagine elettroniche 2007;10(1); http://www.medicoebambino.com/index.php ?id=OAE0701_10.html
16. Kairys SW, Olmstead EM, O’Connor GT. Steroid treatment of laryngotracheitis: a metaanalysis of the evidence of randomised trials. Pediatrics 1989;83:683-93.
17. Russell K, Wiebe N, Saenz A, et al. Glucocorticoids for croup. Cochrane Database Syst Rev 2004; Issue 1:CD001955.
18. Baumer HJ. Glucocorticoid treatment in croup. Arch Dis Child Educ Pract Ed 2006;91: ep58-ep60.
19. Amir L, Hubermann H, Halevi A, Mor M, Mimouni M, Waisman Y. Oral betamethasone versus intramuscular dexamethasone for the treatment of mild to moderate viral croup: a prospective, randomized trial. Pediatr Emerg Care 2006;22(8):541-4.
20. Bjornoson CL, Klassen TP, Williamson J, et al. Treatment of mild croup with a single dose of oral dexamethasone: a multicenter, placebo-controlled trial. N Engl J Med 2004; 315: 1306-13.
21. Marchetti F, Longo G, Ventura A. Dexamethasone for mild croup. N Engl J Med 2004;351(26):2768-9.
22. British National Formulary. BNF for children. London: BMJ Publishing, 2005:158.
23. Geelhoed GC, Macdonald WB. Oral dexamethasone in the treatment of croup: 0.15 mg/kg versus 0.3 mg/kg versus 0.6 mg/kg. Pediatr Pulmonol 1995;20(6):362-8.
24. Sparrow A, Geelhoed G. Prednisolone versus dexamethasone in croup: a randomised equivalence trial. Arch Dis Child 2006;91:580- 8.
25. Geelhoed GC, Turner J, Macdonald WB. Efficacy of a small single dose of oral dexamethasone for outpatient croup: a double blind placebo controlled clinical trial. BMJ 1996;313(7050):140-2.
26. Canciani M, Longo G. Novità nella terapia del croup. Medico e Bambino 1995;14(3):128- 30.
27. Griffin S, Ellis S, Fitzgerald-Baroon A, Rose J, Egger M. Nebulised steroid in the treatment of croup: a systematic review of randomised controlled trials. Br J Gen Pract 2000; 50:135-41.
28. Roorda RJ, Walhof CM. Effects of inhaled fluticasone propionate administered with metered dose inhaler and spacer in mild to moderate croup: a negative preliminary report. Pediatr Pulmonol 1998;25:114-7.
29. Marchetti F, Bua J, Lazzerini M. Oral or inhaled corticosteroids for the treatment of croup? Arch Dis Child Ed Pract 2007;92:ep13.
30. Fitzgerald DA, Mellis CM, Johnson M, et al. Nebulized budesonide is as effective as nebulized adrenaline in moderately severe croup. Pediatrics 1996;97:722-25.
31. Roberts GW, Master VV, Staugas RE, et al. Repeated dose inhaled budesonide versus placebo in the treatment of croup. J Paediatr Child Health 1999;35:170-4.
32. Geelhoed GC. Budesonide offers no advantage when added to oral dexamethasone in the treatment of croup. Pediatr Emerg Care 2005;21(6):359-62.
33. Gardner HG, Powell KR, Roden VJ, et al. The evaluation of racemic epinhephrine in the treatment of infection croup. Pediatrics 1973; 52:52-5.
34. Taussig IM, Castro O, Beaudry PH, et al. Treatment of laryngotracheo-bronchiolitis (croup). Am J Dis Child 1978;132:484-7.
35. Fogel JM, Berg LJ, Gerber MA, et al. Racemic epinhephrine in the treatment of croup: nebulization alone versus nebulization with intermittent positive pressure breathing. J Pediatr 1982;101:1028-31.
36. Kuusela AL, Vesikari T. A randomized double- blind, placebo-controlled trial of dexamethasone and racemic epinephrine in the treatment of croup. Acta Paediatr Scand 1988; 77:99-104.
37. Kelley PB, Simon JE. Racemic epinephrine use in croup and disposition. Am J Emerg Med 1992;10:181-3.
38. Waisman Y, Klein BL, Boenning DA, et al. Prospective randomised double-blind study comparing L-epinephrine and racemic epinephrine aerosols in the treatment of laryngotracheitis (croup). Pediatrics 1992;89:302-6.
39. Martinez FA, Sanchez GE, Rica EI, et al. Randomized double-blind study of treatment of croup with adrenaline and/or dexamethasone in children. Anales Espanoles de Pediatria 1993;38:29-32.
40. Prendergast M, Jones JS, Hartman D. Racemic epinephrine in the treatment of laryngotracheitis: can we identify children for outpatient therapy? Am J Emerg Med 1994;12: 613-6.
41. Ledwith CA, Shea LM, Mauro RD. Safety and efficacy of nebulized racemic epinephrine in conjunction with oral dexamethasone and mist in the outpatient treatment of croup. Ann Emerg Med 1995;25:331-7.
42. Fitzgerald DA, Kilham HA. Croup: assessment and evidence-based management. MJA 2003;179(7):372-7.
Corrispondenza: marchetti@burlo.trieste.it