Question

A 4-year-old boy presents with low-grade fever, inspiratory stridor, and barking cough for the past 5 days. Examination reveals a hoarse voice, a moderately inflamed pharynx, and a slightly increased respiratory rate. His chest x-ray showed subglottic narrowing appearing like a steeple. Which among the following is not indicated in the treatment of this condition?

• A. Nebulized racemic epinephrine
• B. Parenteral cefotaxime
• C. Helium oxygen mixture
• D. Intramuscular dexamethasone

Hint:

Croup is most commonly viral and responds well to supportive treatment including steroids and nebulized epinephrine. Antibiotics should only be used if a bacterial infection is suspected.

Answer 1

The Correct Option is B

Nebulized racemic epinephrine: This is commonly used in croup (laryngotracheobronchitis) to relieve airway edema and stridor. Racemic epinephrine is effective in reducing the symptoms and is part of the standard treatment for moderate to severe cases of croup.
Parenteral cefotaxime: This is not indicated. Croup is typically a viral infection, often caused by the parainfluenza virus, and does not require antibiotics unless there is suspicion of a bacterial infection (such as bacterial tracheitis). Cefotaxime is used for bacterial infections, not viral conditions like croup.
Helium oxygen mixture: Helium-oxygen mixtures are sometimes used in severe cases of croup to improve airflow due to the low resistance and improved delivery of oxygen to the lungs, especially in severe cases with respiratory distress.
Intramuscular dexamethasone: Dexamethasone is a corticosteroid that helps reduce inflammation in the airway and is routinely used in the management of croup to decrease symptoms and prevent worsening of airway obstruction. Thus, the correct answer is Parenteral cefotaxime (2), as it is not indicated in the viral condition of croup unless a secondary bacterial infection is suspected.