Management and Prevention Strategies for Respiratory Syncytial Virus (RSV) Bronchiolitis in Infants and Young Children: A Review of Evidence-Based Practice Interventions

Allison C. Cooper; Nancy Cantey Banasiak; Patricia Jackson Allen

Disclosures

Pediatr Nurs. 2003;29(6) 

In This Article

Pharmacotherapy

Multiple medications with various mechanisms of action have been used in the treatment of children with RSV infection. These medications include bronchodilators, corticosteroids, and antivirals (AHRQ, 2003).

Bronchodilators

Since bronchiolitis and asthma present with similar symptoms, Beta 2-agonists (i.e., albuterol) have been used with little data to support their use. A review by Kellner, Ohlsson, Gadomski, & Wang (2003) showed that bronchodilators had short-term positive effects on respiratory status but did not alter hospitalization rates. Flores and Horwitz (1997) found no improvement in oxygenation or reduction in hospitalization rates with the use of albuterol.

Racemic Epinephrine. Menon, Sutcliffe, and Klassen (1995) found racemic epinephrine, which has both a-adrenergic and b-adrenergic activity, was better than albuterol in reducing hospitalization of infants age 6 weeks to 1 year with bronchiolitis presenting to the ER. They found that only 30% of the 21 infants treated with racemic epinephrine required hospitalization as compared to 75% of the 21 infants treated with albuterol. The total number in this study was too small to recommend this treatment modality without further study. Patel, Platt, Pekeles, and Ducharme (2002) randomized 149 hospitalized infants with bronchiolitis into three treatments groups; 50 receive racemic epinephrine, 51 received nebulized albuterol, and 48 received a placebo. The authors found no difference in the effectiveness of therapy for infants hospitalized with bronchiolitis.

Corticosteroids

Research has shown that corticosteroids, systemic or inhaled, do not seem to exhibit the same beneficial respiratory effects in infants with RSV bronchiolitis as they do in children with severe asthma and, thus, are not recommended (AAP, 2003; AHRQ, 2003; Cade et al., 2000; CHMC, 2001; De Boeck, Van der Aa, Van Lierde, Corbeel, & Eeckels, 1997; Roosevelt et al., 1996). A meta-analysis by Garrison et al. (2000) found infants receiving corticosteroids had a reduction in length of stay of 0.43 days compared to the placebo treatment. However, several studies were excluded and upon further analysis there was found to be no difference in length of stay (CHMC, 2001).

The AHRQ (2003) recommends additional, large, well-designed studies be conducted before evidence-based recommendations can be made for the use of albuterol, racemic epinephrine, or corticosteroids in the management of RSV infections.

Antivirals

Ribavirin. Aerosolized ribavirin is the only specific antiviral drug that is licensed for the treatment of RSV infection of infants and young children in the United States (AHRQ, 2003). Because ribavirin acts to inhibit viral replication, the earlier it is used in the course of acute RSV infection, the greater the likelihood it will be beneficial (Rodriguez, 1999). One recent study found the use of ribavirin early in the course of RSV infection in previously healthy infants reduced both the incidence and severity of recurrent wheezing episodes later in life (Edell, Khoshoo, Ross, & Salter, 2002). But other studies have not found ribavirin therapy to reduce either mortality rates or duration of mechanical ventilation (Everard, Swarbrick, Rigby, & Milner, 2001; Guerguerian, Gauthier, Lebel, Farrell, & Lacroix, 1999; Moler, Steinhart, Ohmit, & Stidham, 1996). Thus, ribavirin appears to have limited clinical efficacy in previously healthy infants with severe RSV infection.

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