CHALLENGES IN THE MANAGEMENT OF BRONCHIOLITIS

Abstract

ABSTRACT
Objective: This study aims to review and evaluate current medication and to provide practical guidelines to the practitioners managing children with
bronchiolitis.
Methods: A 6-month retrospective study was carried out in the Department of Paediatrics in Tertiary Care Hospital, a 350-bedded multispecialty
hospital to review the management of bronchiolitis. A total of 60 cases selected from July 2014 to December 2014 were included in the study. Patient
data and prescription details were recorded and analyzed accordingly.
Results: About 58.3% of bronchiolitis cases were reported in the age group of <1 year, 26.6% in the age group of 1-2 years and 15% cases
reported at the age >2 years. Commonly reported symptoms in different cases include 85% of cases with fever, 90% with a cough, 93.3% with
cold, 30% with vomiting, 35% with breathlessness, 33.3% with loose motions, and 68.3% with wheezing. A single broad-spectrum antibiotic
was used in 68.3% cases, two broad spectrum antibiotics in 26.6% of cases, and three or more combinations in 5% of cases to prevent bacterial
coinfections. A careful assessment of study has evaluated that antiviral therapy was not used in any of the cases to avoid antiviral resistance
but broad-spectrum antibiotics were most commonly prescribed for a viral respiratory illness which is generally self-limiting adding to the
threat of antibiotic resistance. Bronchodilators and corticosteroids were routinely used. As per current Standard Treatment Guidelines for the
management of bronchiolitis, the priority has been given to adequate rest, intravenous fluids, symptomatic therapy, and reserve antiviral therapy
for special cases. This study demonstrated the importance of routine medication review and the need of a clinical pharmacist at various levels
of clinical setup.
Conclusion: From this study, it can be concluded that interventions by a clinical pharmacist are needed in taking a special effort to analyze prescriptions
and provide clinicians with a feedback involving available antiviral medications, antiviral resistance, prescription costs, limitations of antiviral agents
and updated current standard treatment guidelines.
Keywords: Self-limiting, Antiviral therapy, Antiviral resistance, Antibiotic use, Antibiotic resistance.