A 3-year-old unvaccinated child develops croup (laryngotracheobronchitis). This child had barking cough, stridor, and fever for 2 days and is now stridorous at rest with mild retractions. Westley Croup Score is 5 (moderate croup). Which treatment combination is evidence-based for this severity?
- A Humidified oxygen + oral dexamethasone 0.15 mg/kg
- B Single dose oral/IM dexamethasone 0.6 mg/kg + nebulized epinephrine (racemic or L-epinephrine 1:1000) ✓
- C Nebulized budesonide alone 2 mg + observation for 2 hours
- D IV methylprednisolone + helium-oxygen (Heliox) mixture
Explanation
Moderate croup (Westley score 3–5) is managed with oral or IM dexamethasone 0.6 mg/kg (single dose; oral bioavailability equals IM) combined with nebulized epinephrine (racemic epinephrine 2.25% or L-epinephrine 1:1000, 5 mL). Nebulized epinephrine provides rapid but transient (2–3 hour) relief of subglottic edema; patients must be observed for at least 2–3 hours after for rebound. Dexamethasone (0.15 mg/kg) is adequate for mild croup but 0.6 mg/kg is standard for moderate-severe. Nebulized budesonide alone has equivalent efficacy to oral dexamethasone but is more expensive and used when oral route is unavailable.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.