From the Guidelines
Treatment for infectious bronchiolitis primarily involves supportive care since most cases are caused by viruses, particularly respiratory syncytial virus (RSV). The mainstay of treatment includes ensuring adequate hydration through oral fluids or, if necessary, intravenous fluids for severely dehydrated patients. Nasal suctioning with saline drops can help clear secretions and improve breathing, especially before feedings. Supplemental oxygen should be provided if oxygen saturation falls below 90-92% 1. Most medications have limited effectiveness in bronchiolitis. Bronchodilators like albuterol (2.5 mg via nebulizer every 4-6 hours) may be tried but should only be continued if there's clear improvement. Corticosteroids are generally not recommended, as they have not shown sufficient evidence to support their use in this illness 1. Antibiotics should be reserved only for cases with confirmed bacterial co-infection, as their routine use is not recommended 1. For severe cases requiring hospitalization, high-flow nasal cannula oxygen therapy may be used. Most bronchiolitis cases resolve within 1-2 weeks, though cough may persist longer. Prevention strategies include good hand hygiene, avoiding exposure to sick individuals, and for high-risk infants (premature, with heart/lung conditions), palivizumab prophylaxis may be considered during RSV season. Some key points to consider in the management of bronchiolitis include:
- The use of ribavirin is not recommended for routine use in children with bronchiolitis, due to its marginal benefit and potential health risks for caregivers 1.
- The diagnosis of bronchiolitis is primarily clinical, and laboratory tests are not necessary for diagnosis, but may be useful in certain situations, such as identifying co-infections or underlying conditions.
- The management of bronchiolitis should focus on supportive care, with a goal of reducing symptoms and preventing complications, rather than treating the underlying viral infection.
From the FDA Drug Label
VIRAZOLE® (Ribavirin for Inhalation Solution, USP) is indicated for the treatment of hospitalized infants and young children with severe lower respiratory tract infections due to RSV. Treatment early in the course of severe lower respiratory tract infection may be necessary to achieve efficacy. Only severe RSV lower respiratory tract infection should be treated with VIRAZOLE
The treatment for infectious bronchiolitis due to RSV is ribavirin (VIRAZOLE) inhalation solution, specifically for hospitalized infants and young children with severe lower respiratory tract infections. Treatment should be initiated early in the course of the infection and should be based on the severity of the RSV infection 2.
- The decision to treat with VIRAZOLE should be based on the severity of the RSV infection.
- Underlying conditions such as prematurity, immunosuppression, or cardiopulmonary disease may increase the severity of clinical manifestations and complications of RSV infection.
From the Research
Treatment Overview
The treatment for infectious bronchiolitis is primarily supportive, focusing on relieving symptoms and managing complications.
- The main goals of treatment are to maintain adequate hydration, oxygenation, and ventilation, as well as to prevent further respiratory distress 3, 4, 5, 6, 7.
- Supportive care includes oxygen therapy, fluid management, and nasal suctioning to help clear the airways 3, 4, 5, 6, 7.
Pharmacological Interventions
Several pharmacological interventions have been studied for the treatment of bronchiolitis, but their effectiveness is still debated.
- Bronchodilators, corticosteroids, and antibiotics are not recommended for routine use in bronchiolitis treatment, as they have not shown significant clinical benefits 4, 5, 6, 7.
- Ribavirin, an antiviral medication, is not commonly used due to its limited efficacy and potential side effects 3, 4, 5.
- Nebulized hypertonic saline and adrenaline may be useful in some cases, but their use is not widely recommended 5, 7.
Prevention and Prophylaxis
Prevention and prophylaxis play a crucial role in managing bronchiolitis, especially in high-risk infants.