BRONCHIOLITIS
This is an acute viral infection of the bronchioles occurring in infants
under 10 months of age which can lead to fatal acute respiratory failure. It
tends to occur in epidemics during the cold seasons.
Bronchiolitis has a high mortality rate so it should ideally be treated in
hospital.
CAUSES
· Viruses e.g. respiratory syncytial virus, parainfluenza virus
SYMPTOMS
· Onset often follows a cold
· Low grade fever
· Cough
· Breathlessness
· Wheezing
138
DISORDERS OF THE RESPIRATORY SYSTEM
SIGNS
· Fast breathing
· Distension of nasal margins (alar flare)
1/5
· Intercostal recession
· On auscultation there are rhonchi and crepitations
· Cyanosis (blue discolouration of lips, tongues and finger tips) if severe
INVESTIGATION
· FBC
· Chest X-ray
TREATMENT
Treatment objectives
· To avoid worsening of obstruction by thick secretions
· To prevent hypoxia
· To prevent and ensure prompt treatment of respiratory failure
· To detect and promptly treat heart failure
· To treat secondary bacterial infection
Non-pharmacological treatment
· Prop the child up or hold in a sitting position
· Keep well hydrated but avoid fluid overload
Pharmacological treatment
(Evidence rating: C)
· Humidified air enriched with oxygen
· IV Fluid Normal Saline in 4.3 Dextrose (given to distressed infants
who cannot suck)
Antibiotics (given to very sick infants with suspected secondary
bacterial infection)
· Amoxicillin (Amoxycillin), oral,
Children
6-12 years; 250 mg 8 hourly for 7 days
1-5 years; 125 mg 8 hourly for 7 days
<1 year; 62.5 mg 8 hourly for 7 days
Or
Co-amoxiclav, oral,
Children
> 12 years; One 500/125 tablet 12 hourly for
7 days
6-12 years; 5 ml of 400/57 suspension
12 hourly for 7 days
139
DISORDERS OF THE RESPIRATORY SYSTEM
1-6 years; 2.5 ml of 400/57 suspension
12 hourly for 7 days
1month-1 year; 0.25 ml/kg body weight of 125/31
suspension 8 hourly for 7 days
< 1 month; 0.25 ml/kg body weight of 125/31
suspension 8 hourly for 7 days
Double the dose in severe infections
For patients allergic to penicillin:
· Erythromycin, oral,
Children
8-18 years; 250-500 mg 6 hourly for 7 days
2-8 years; 250 mg 6 hourly for 7 days
6 months -2 years; 125 mg 6 hourly for 7 days
Or
Azithromycin, oral,
Children
> 6 months; 10 mg/kg once daily for 3 days
Close monitoring and possible intubation and ventilation may be
required. Bronchodilators and corticosteroids are NOT effective and
should not be given.
REFER
Refer all severely distressed infants to a regional hospital.
