Antibiotics do not cure viral infections, but viruses do lower the patient’s resistance to bacterial infections. When such a combined infection occurs, antibiotics may be recommended. When an antibiotic is prescribed, it should be taken as the physician directs for the full course (usually 7-10 days). Otherwise the infection may not be completely eliminated, and could return. Some children will experience recurrent infection despite antibiotic treatment. When some of these are strep infections or are severe, your child may be a candidate for a tonsillectomy.
Since the 1970s, corticosteroid use for croup has been debated. A 1989 meta-analysis by Kairys 21 demonstrated benefit in the inpatient setting. More recently, results of a meta-analysis showed that treatment with glucocorticoids is effective in improving symptoms within six hours, for up to 12 hours, with significant improvement in croup scores, shorter hospital stays, and less use of epinephrine. 2 [Evidence level A: meta-analysis of randomized controlled trials (RCTs)] A Cochrane review of 24 studies involving more than 2,000 children concluded that treatment with corticosteroids reduces the Westley croup score at six hours. 22 [Evidence level A: meta-analysis of RCTs] However, most of the included studies took place in emergency departments or on the hospital floor after admission. While it seems clear that steroids provide benefit in the treatment of croup, more recent studies have tried to determine the optimal method of administration and the applicability of the treatment in the office setting.
Transdermal patches (adhesive patches placed on the skin) may also be used to deliver a steady dose through the skin and into the bloodstream. Testosterone-containing creams and gels that are applied daily to the skin are also available, but absorption is inefficient (roughly 10%, varying between individuals) and these treatments tend to be more expensive. Individuals who are especially physically active and/or bathe often may not be good candidates, since the medication can be washed off and may take up to six hours to be fully absorbed. There is also the risk that an intimate partner or child may come in contact with the application site and inadvertently dose himself or herself; children and women are highly sensitive to testosterone and can suffer unintended masculinization and health effects, even from small doses. Injection is the most common method used by individuals administering AAS for non-medical purposes.