Background and importance Bronchiolitis is a common cause of hospitalisation in infants. Clinical guideline recommendations are based on supportive treatment. Pharmacological treatment is reserved for severe cases
Aim and objectives To analyse the prescription of recommended drugs used for the treatment of bronchiolitis in bronchiolitis patients under the care of the paediatric service (PS).
Material and methods A retrospective observational study was conducted in a regional hospital. We selected drugs recommended by paediatrics guidelines. Bronchiolitis inpatients with any of these drugs prescribed by the PS during January 2020 were included. Data collected were: demographics, length of admission, respiratory syncytial virus (RSV) test results, bronchiolitis treatment, oxygen therapy, oxygen saturation, respiratory rate, wheezing, accessory muscles use and antibiotic therapy. Bronchiolitis treatment was classified according to its therapeutic activity: bronchodilators: epinephrine, salbutamol, and ipratropium; glucocorticoids: methylprednisolone and prednisolone; and hypertonic serum (SH). Patients were classified according to the Wood–Downes severity scale (WDS) and the prescribed treatment. The data were collected from the electronic prescription programme and digital medical records.
Results 48 patients were included, 25 (52%) females, mean age 3 months (0.77–11). Average stay was 4 days (1–7). 34 (70%) patients were positive for RSV and 2 (5%) were also positive for influenza A virus. Patients classified according to the WDS scale and mean number of drugs during admission were: patients with a mild condition 8 (16%), 2.25 drugs; patients with a moderate condition 23 (47%), 2.08 drugs; and patients with a severe condition 17 (35%), 2.64 drugs. Drugs during admission for all patients included: 3 (6%) patients were treated with palivizumab previously, 2 in the previous season and 1 in the current season; 6 (12%) were treated with antibiotic therapy alone or in combination (6 (100%) clavulanic amoxicillin, 3 (50%) ampicillin, 1 (2%) cloxacillin and 1 (2%) cefotaxime); 46 (95%) patients were treated with SH; 35 (73%) with adrenaline; 18 (37%) with salbutamol; and 14 (29%) with corticosteroid therapy. 35 (73%) inpatients received oxygen therapy during admission and the mean PO2 on admission for these patients was 94%. Mean PO2 at admission for patients who did not receive oxygen therapy was 96%.
Conclusion and relevance There were no differences between patient severity and number of prescribed drugs. The study highlighted the prescriptions of salbutamol and adrenaline despite the limited evidence of use in bronchiolitis. In our study, oxygen therapy was applied when oxygen saturations were above recommendations. The treatment used in bronchiolitis should be reviewed, promoting a rational use of the drug and therapies based on evidence, avoiding over medication.
Conflict of interest No conflict of interest
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