A 3-year-old presents with acute onset 'seal-bark' cough, low-grade fever, and inspiratory stridor. X-ray neck shows the 'steeple sign.' The diagnosis is croup (laryngotracheobronchitis). The FIRST-LINE treatment for moderate croup is:

• A IV ampicillin-sulbactam for 48 hours
• B Nebulised racemic epinephrine only, no steroids
• C Single dose oral or nebulised dexamethasone/budesonide ✓
• D Immediate nasotracheal intubation and admission to ICU

Explanation

Croup (laryngotracheobronchitis) is caused mainly by parainfluenza virus (type 1 most common). For moderate croup, current evidence-based guidelines (based on multiple RCTs) support a single dose of oral dexamethasone (0.15–0.6 mg/kg) or nebulised budesonide as first-line treatment. Corticosteroids reduce mucosal oedema, shorten hospital stay, and decrease need for further interventions. Nebulised racemic/L-epinephrine is added for severe croup. Antibiotics have no role (viral aetiology). Intubation is reserved for severe respiratory failure.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.