Antibiotics For Bronchiolitis In Children Under Two Years Of Age
Question
We reviewed the evidence on the effect of antibiotics on clinical outcomes in children with bronchiolitis.
Background
Bronchiolitis is a serious respiratory illness that affects babies. It is most commonly caused by respiratory syncytial virus and is the most common reason for hospitalisation in babies younger than six months. Babies usually present with runny nose, cough, shortness of breath and signs of difficulty in breathing, which can become life-threatening. Despite its viral cause, antibiotics are often prescribed. Prescribers may be expecting benefits from anti-inflammatory effects attributed to some antibiotics or be concerned about secondary bacterial infection, particularly in children who are very unwell and require intensive care. We wanted to discover if antibiotics improved or worsened clinical outcomes in children with bronchiolitis.
Study characteristics
This evidence is current to June 2014. We identified seven trials comparing antibiotics with placebo or no antibiotics in children with bronchiolitis. Two of these studies also compared intravenous and oral antibiotics.
Key results
Our primary outcome was duration of symptoms/signs , fever). Secondary outcomes included duration of admissions/time to discharge from hospital, readmissions, complications/adverse events and radiological findings.
Quality of the evidence
Can I Treat A Cold With An Antibiotic
Using an antibiotic for a virus, like a cold or the flu:
- will not cure the virus
- wont help you feel better
- will not prevent others from catching your virus
- will be a waste of your money.
Many bacterial infections do require an antibiotic however, the type of antibiotic will vary based on the type of infection. An antibiotic either prevents bacterial growth or kills bacteria outright .
It is very important not to share your antibiotics with someone else. For example, amoxicillin can be used to treat a bacterial strep throat but will not work for some common pneumonias or bladder infections.
While you may mean well if you share your medicine, the bacteria causing someone else’s infection may not be susceptible to your prescribed antibiotic. In turn, those bacteria may not die and that person’s infection can worsen. Plus, the person you share your antibiotic with may experience side effects or serious allergic reactions from your drug. Overall, sharing any medicine with someone else is risky business.
Antibiotics Aren’t Used Because Rsv Is A Virus
Fortunately, most cases of RSV are mild and require no specific treatment from doctors. Antibiotics aren’t used because RSV is a virus and antibiotics are only effective against bacteria. Medication may sometimes be given to help open airways and to improve breathing.
In an infant, however, an RSV infection can be more serious and may require hospitalization so that the baby can be watched closely. He or she may require more fluids and possibly treatment for breathing problems.
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What Can I Do If My Child Is Sick
- Keep your child as comfortable as possible and offer plenty of fluids.
- Give acetaminophen or ibuprofen for fever. Ibuprofen should only be given if your child is drinking reasonably well. Do not give ibuprofen to babies under 6 months old without first talking to your doctor.
- If your baby is having trouble drinking, try to clear nasal congestion gently with a bulb syringe or with saline nose drops.
- Do not give over-the-counter cough and cold medicines to a child younger than 6 years old. Although these drugs do not need a doctors prescription, they are not safe in young children.
- If you are using cough and cold medicines for children older than 6 years, read instructions carefully and give only the recommended dose.
How Is Rsv Treated
RSV is usually mild and doesnt need any treatment. Most children get better within a week or two. Sometimes children need to be hospitalized so that they can be watched closely and given fluids or oxygen if needed.
Because RSV is a virus, antibiotics will not help a child get better faster. Antibiotics kill bacteria, not viruses.
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Can Rsv Turn Into Something More Serious
Gold says to watch for the main symptoms of RSV, such as difficulty breathing and poor feeding, to worsen. When babies have difficulty breathing, its harder for them to feed from the breast or bottle. Children can get dehydrated, so parents should watch for decreased urine output and poor feeding as signs that RSV is worsening, says Gold. If you notice these symptoms, visit your doctor or the emergency room immediately.
RSV can reduce your childs immune function and make her more susceptible to other viruses. According to the CDC, pneumonia and bronchiolitis are two illnesses that children with RSV can catch. With pneumonia, the lungs become infected, while bronchiolitis involves inflammation of the small airways in the lungs.
Viral pneumonia, like RSV, is a virus that just has to run its course. But if your baby has bacterial pneumonia, your paediatrician will prescribe antibiotics. Bacterial pneumonia can be quite serious and may require hospitalization, says Gold. Bronchiolitis is also a virus, but saline drops and acetaminophen can help ease your childs symptoms. Watch out for signs of dehydration and laboured breathing because, like RSV, your baby may need a hospital stay to restore her fluids and stabilize her oxygen levels.
Rsv: What You Should Know
Lou E. Romig MD, FAAP, FACEP
Medical Director
The Centers for Disease Control and Prevention has announced increased activity of respiratory syncytial virus, known as RSV, across parts of the Southern U.S. Here is what parents and caregivers should know.
What is RSV?
RSV causes symptoms of a cold in school-aged children and adults, but can also cause bronchospasm in infants through toddlers.
When does RSV commonly occur?
RSV is typically a fall and winter virus, but it can occur at any time of the year. Another name for this type of super-cold in infants and young children is bronchiolitis, which can also be caused by several other viruses. Testing for RSV is available, but the diagnosis of bronchiolitis does not require the identification of the virus, as the type of virus does not really influence treatment.
How is RSV treated?
Will breathing treatments help my child?
When do I need to see a doctor for RSV?
If your child with RSV is not having labored breathing, is not vomiting frequently due to hard coughing and is drinking plenty of fluids, theres usually no need for emergency treatment. Please have your child evaluated immediately if they exhibit any of these symptoms:
How long does RSV last?
Is RSV contagious?
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How Should I Treat Rsv At Home
Although there is no specific treatment for RSV, you can take steps to relieve symptoms.
- Manage pain and fever with over-the-counter pain and fever reducers, such as acetaminophen or ibuprofen. Read doses instructions carefully and never administer aspirin to children.
- Drink lots of water to prevent dehydration.
- Ask your health care provider before giving your child any nonprescription cold medications as some ingredients are not safe for children.
How Can I Get My Child Help For Rsv
Since RSV is a virus, antibiotics are not effective in treating it. Luckily, your child will likely get better on their own in about a week.
In the meantime, you can give your child over-the-counter medications, such as acetaminophen or ibuprofen, to help control fever and pain. Contact your childs pediatrician to find out the proper dose.
Contact your pediatrician if your child has any of the following problems:
- For babies younger than 2 months, a temperature greater than 100.4 degrees Fahrenheit
- For babies between 3 to 6 months, a temperature greater than 101 degrees Fahrenheit
- For children older than 6 months, a temperature greater than 103 degrees Fahrenheit
Your pediatrician can evaluate how severe the infection is. Some children may need treatment in the hospital.
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How Rsv Is Diagnosed
Mild RSV infections usually cause problems just in the upper respiratory tract . Mild cases have the same symptoms as the common cold and dont need a lab test.
When RSV causes a lower respiratory tract infection , a health care provider will usually diagnose it. Providers will examine patients and ask them or their caregiver questions about the illness. These RSV cases start as an upper respiratory illness that gets worse over a few days. Patients have more and more trouble breathing. They start wheezing and can hear crackles in both lungs.
Health care providers may suspect bronchiolitis because of RSV if there have been many cases in the community. Although RSV can occur at any time, it is much more likely during colder months. However, the exact timing of the RSV season varies across the country. You can find out when RSV season has begun from the Centers for Disease Control and Prevention or your local health department.
If patients with RSV need to stay in the hospital, they will be given a test to confirm the virus. This is useful because such patients can be safely isolated, which will keep RSV from spreading to other patients.
Several highly accurate RSV tests can give reliable results within a few hours. Health care providers will take a small sample of the patients nasal mucus. Patients who develop severe disease will need more tests to make sure they dont develop other illnesses. These tests include:
Theres Good News Rsv Infection Is Entirely Preventable
There are a number of things you can do to protect your child from RSV. Firstly, keep babies under 6 months old away from people with colds, and clean and disinfect hard surfaces. Wash your hands and your childrens hands often to reduce the spread of germs.
Breastfeeding your baby can also help protect against RSV and other illnesses. Breast milk contains antibodies and other immune factors that help prevent and fight off illnesses.
Make sure your child receives all recommended vaccines. Immunizations wont prevent your child from getting a cold, but they will protect your child from some of the complications a cold can cause. And lastly, avoid smoking in the same room or car with your child. Exposure to tobacco smoke can increase the risk of RSV illness.
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What Are The Symptoms Or Signs Of Rsv
Symptoms usually show within 4-6 days after getting infected and include:
Symptoms usually appear in stages. In infants, watch for irritability, a decrease in activity or appetite, and breathing difficulty . Fever isnt always present with RSV.
Rashes are not common with RSV, but they are common with viruses such as measles, rubella, rubeola, chickenpox and fifth disease.
How Can I Prevent My Baby From Getting Rsv
As with colds, there isnt one magical thing you can do to prevent RSV, but you can take measures to minimize your risk.-Wash your hands: Since youre preparing your babys food and doing pretty much everything else for her, be sure to wash your hands. Wash them before you pick up your baby and whenever you handle anything thats going in her mouth.-Keep surfaces clean: Since RSV lives on surfaces, be sure to wipe down anything that your baby will come in contact with, including toys .-Keep your baby away from sick people: You wouldnt intentionally let your baby hang around with other babies or grown-ups who are sick, but once you know someone is ill, its time to go.
If your baby has picked up RSV before, she can still get it againeven during the same RSV seasonso be proactive about prevention.
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What Are Risk Factors For Rsv
These situations make it more likely a person will catch RSV:
- Crowded places with people who may be infected
- Exposure to other children or to older brothers or sisters being schooled at home
These people are at higher risk for severe forms of RSV:
- Babies younger than 6 months of age
- Babies born prematurely
- Adults with asthma, congestive heart failure, or chronic obstructive pulmonary disease
- Patients with Down syndrome
When Should You Call Your Doctor
if your baby or child has moderate trouble breathing.
- Breathes slightly faster than normal and seems to be getting worse. Most healthy children breathe less than 40 times a minute.
- Has cold symptoms that become severe.
- Has shallow coughing, which continues throughout the day and night.
- Has a poor appetite or is being less active than usual.
- Has any trouble breathing.
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Will There Ever Be A Vaccine For Rsv
After decades of research, with numerous setbacks, several RSV vaccine contenders are finally getting close to the finish line. While COVID-19 slowed and complicated the RSV vaccine trials, it also opened up some new avenues of investigation.
Moderna, for example, is currently testing an RSV vaccine for people over age 60 based on the same mRNA technology it used to develop its COVID-19 shots. On February 22, the company announced that its RSV shot will enter phase 3 testing . It will join three other phase 3 candidates for older adults from Pfizer, GlaxoSmithKline, and Johnson & Johnson.
Researchers are also homing in on a vaccine for babies either through direct inoculation or maternal vaccination. Newborns are highly vulnerable to RSV, but vaccines dont tend to be effective until a baby is at least 2 months old, McCulloch explains. Vaccinating mothers, who can pass the antibodies on to their babies, is a strategy already used with flu and pertussis , she notes.
On March 2, Pfizer’s maternal vaccine candidate received a breakthrough designation from the U.S. Food and Drug Administration, which means it will be able to move more quickly through the next phases of testing, as well as the vaccine approval process.
What Can Be Done To Prevent The Spread Of Rsv
At this time, two products that contain RSV antibodies are available to prevent RSV infection. These products are given once a month during the RSV season and are recommended for certain high-risk children. When RSV infections are noted in a facility such as a hospital or nursing home, contact isolation and hand washing by health care workers have been shown to limit spread of the virus. As with any respiratory illness, all people should cover their face when coughing and sneezing.
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When To Use Home Treatment
Most mild to moderate respiratory syncytial virus infections in otherwise healthy people are like the common cold and can be treated at home. If your child is older than 12 months of age and is not at risk for complications from RSV infection, try home treatment. But RSV infections in people with an increased risk of complications need close monitoring.
People who have impaired immune systems need to see a doctor for cold symptoms because of the increased risk for complications. Also, babies and childrenâand older adultsâwho have health problems and other risk factors should see a doctor at the first sign of RSV.
What Can I Do To Prevent Getting Respiratory Syncytial Virus Or Prevent Spreading Rsv If Infected
You can follow the same precautions that one follows if they have the cold, flu or any other contagious disease:
- Wash your hands often. Wash for 20 seconds. If soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60% alcohol.
- Avoid touching your eyes, nose and mouth to prevent the spread of viruses from your hands.
- Cover your mouth and nose with a tissue when sneezing and coughing or sneeze and cough into your elbow. Throw the tissue in the trash. Wash your hands afterward. Never cough or sneeze into your hands!
- Avoid close contact with those who have known RSV, coughs, colds or are sick. Stay home if you are sick.
- Dont share cups, toys or bottles, or any objects. Viruses may be able to live on such surfaces for hours .
- If you are prone to sickness or have a weakened immune system, stay away from large crowds of people.
- Clean frequently used surfaces with a virus-killing disinfectant.
Additional tips for children:
- Keeping your children home from day care when they or other children become ill.
- If you have a child at high risk of developing severe RSV, try to limit time at child care centers or gatherings of large number of children during the RSV season.
- Wash toys frequently.
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Rsv Can Cause More Serious Health Problems
RSV can also cause more severe infections such as bronchiolitis, an inflammation of the small airways in the lung, and pneumonia, an infection of the lungs. It is the most common cause of bronchiolitis and pneumonia in children younger than 1 year of age.
Healthy adults and infants infected with RSV do not usually need to be hospitalized. But some people with RSV infection, especially older adults and infants younger than 6 months of age, may need to be hospitalized if they are having trouble breathing or are dehydrated. In the most severe cases, a person may require additional oxygen or intubation with mechanical ventilation . In most of these cases, hospitalization only lasts a few days.
Unnecessary Antibiotic Treatment Of Children Hospitalised With Respiratory Syncytial Virus Bronchiolitis: Risk Factors And Prescription Patterns
Respiratory syncytial virus is a major cause of paediatric respiratory infections.
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RSV infections are often inappropriately treated with antibiotics.
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Patient characteristics indicating a more severe state are associated with antibiotic misuse.
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Antimicrobial stewardship and decision support systems can help mitigate antibiotic misuse.
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