Treatment of Parainfluenza in Children
The treatment of parainfluenza in children is primarily supportive care, including adequate hydration, antipyretics for fever, and close monitoring for respiratory distress, as there are no specific antiviral medications approved for parainfluenza infections. 1, 2
Supportive Care Management
- Ensure adequate hydration with oral fluids or intravenous support if the child is severely ill or unable to maintain oral intake 1
- Administer antipyretics (e.g., acetaminophen) to manage fever and discomfort 1
- Monitor for signs of respiratory distress that may require hospital admission 1
- Provide supplemental oxygen therapy for children who are hypoxic 1
Indications for Hospital Admission
- Signs of respiratory distress including:
- Markedly raised respiratory rate
- Grunting
- Intercostal recession
- Breathlessness with chest signs 1
- Cyanosis 1
- Severe dehydration 1
- Altered conscious level 1
- Complicated or prolonged seizure 1
- Signs of septicemia—extreme pallor, hypotension, floppy infant 1
Hospital Management
- Most children admitted to hospital will need:
- Oxygen therapy for hypoxia
- Intravenous fluid support
- Antibiotics if bacterial co-infection is suspected 1
Antibiotic Therapy
- Antibiotics should be considered for children who are:
- At risk of complications
- With disease severe enough to merit hospital admission 1
- Co-amoxiclav is the drug of choice for children under 12 years 1
- Clarithromycin or cefuroxime should be used in children allergic to penicillin 1
- For severely ill children with pneumonia, a second agent (e.g., clarithromycin or cefuroxime) should be added and administered intravenously 1
Diagnostic Testing
- For hospitalized children:
- Full blood count with differential
- Urea, creatinine and electrolytes
- Liver enzymes
- Blood culture
- Chest x-ray (if hypoxic, severely ill, or deteriorating despite treatment)
- Pulse oximetry 1
- Viral testing:
Special Considerations
- Unlike influenza, there are no FDA-approved antiviral medications specifically for parainfluenza virus infections 2
- Oseltamivir (Tamiflu), zanamivir, and other neuraminidase inhibitors used for influenza are not effective against parainfluenza viruses 1
- For laryngotracheitis (croup) caused by parainfluenza, corticosteroids and epinephrine may be beneficial 4
Experimental Treatments
- DAS181, a novel sialidase fusion protein inhibitor, has shown promise in treating parainfluenza infections in immunocompromised children but is not yet FDA-approved for routine use 5
Prevention
- No vaccine is currently available for parainfluenza viruses 2
- Infection control measures are crucial, especially in healthcare settings:
- Proper hand hygiene
- Isolation or cohorting of infected patients
- Use of personal protective equipment 6
Prognosis
- Most immunocompetent children recover completely with supportive care 7
- Parainfluenza infections can be more severe in infants, immunocompromised children, and those with underlying respiratory conditions 7, 5
- Complications may include pneumonia, bronchiolitis, and croup 7
Remember that parainfluenza is distinct from influenza, and antiviral medications designed for influenza (such as oseltamivir) are not effective against parainfluenza viruses. The cornerstone of treatment remains supportive care while monitoring for and managing complications.