Treatment of Moderate Croup in HPIV Treatment of croup in HPIV infection depends upon the severity of symptoms. In case of moderate croup, cool oxygen mist and steroids are employed. Initially, dexamethasone was administered intramuscularly. According to some studies, dexamethasone is more effective orally. In some patients, corticosteroid therapy does not alleviate the condition. Such patients are switched to racemic epinephrine with nebulizer. In this therapy, there is possible risk of developing laryngospasm after the dose wears off which needs immediate medical attention. After administering the therapy, observe the patient for at least 3 hours to gauge alleviating or worsening of condition. Under intensive care monitoring, repeat racemic epinephrine nebulization after intervals of 1-2 hours. In case of severe respiratory obstruction, endotracheal intubation followed by tracheotomy is required. However, less than 5% patients of sever croup need artificial respiratory support. Administer IV fluids to maintain hydration.