If a patient with croup does not respond to racemic epinephrine, which therapy is indicated?

• A. Antibiotics
• B. Antivirals
• C. Antihistamines
• D. Corticosteroids

Answer: (D)

Corticosteroids are used when croup persists after trying a fast-acting bronchodilator because they address the underlying inflammation that narrows the airway. Racemic epinephrine can quickly reduce mucosal edema, but its effect is short-lived; if symptoms don’t improve, reducing subglottic swelling with steroids provides longer-lasting relief and can prevent deterioration.

Antibiotics aren’t indicated for routine viral croup unless there’s a definite bacterial infection; antivirals aren’t standard treatment for typical croup; antihistamines don’t help with croup-related airway edema and can cause unwanted side effects. Corticosteroids, such as dexamethasone, are the appropriate next step to reduce airway inflammation and improve outcomes.