A 2-year-old child presents with a barking cough, hoarseness, and inspiratory stridor at rest. Neck radiograph shows the 'steeple sign'. What medication combination is first-line?
Answer and explanation
Correct answer: C. Oral dexamethasone and nebulized epinephrine
- Step 1: Laryngotracheobronchitis (croup), caused primarily by parainfluenza virus, produces subglottic tracheal narrowing characterized by the steeple sign.
- Step 2: Moderate to severe croup with stridor at rest is treated with a single dose of systemic dexamethasone (to reduce laryngeal mucosal inflammation) and nebulized racemic epinephrine (to cause local vasoconstriction and relieve airway obstruction).
Answer
Oral dexamethasone and nebulized epinephrine.
Why not the others: Croup is viral; antibiotics like amoxicillin provide no therapeutic benefit. Ceftriaxone is indicated for bacterial epiglottitis or tracheitis, which presents with high toxic fever, dysphagia, and drooling without a barking cough. Montelukast is a leukotriene antagonist for chronic asthma maintenance with no role in acute laryngeal stridor.
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