What is first-line treatment for mild croup?

• A. Dexamethasone
• B. Nebulized albuterol
• C. Antibiotics
• D. Epinephrine in all cases

Answer: (A)

Reducing airway inflammation quickly is the key goal in mild croup. A corticosteroid does this best, and a single dose of dexamethasone effectively decreases subglottic edema, helping to relieve stridor and the characteristic barking cough for many hours. Its anti-inflammatory effect works well with minimal dosing, so one dose often suffices for mild symptoms and avoids unnecessary interventions.

Nebulized albuterol targets bronchospasm, which isn’t the main issue in typical mild croup, so it isn’t used as the first-line treatment unless there’s concurrent wheezing suggesting an asthma-like component. Antibiotics aren’t indicated because mild croup is usually viral. Epinephrine provides rapid relief for more severe airway obstruction but requires close monitoring due to potential rebound symptoms, so it’s reserved for moderate to severe cases, not mild ones.