The greatest in number common lower...

The greatest in number common lower respiratory tract infection in infants is bronchiolitis, which befalls in 21 percent of infants each year. The greatest in number common etiology is respiratory syncytial virus. through the whole extent of the past few years, the number of hospitalizations for bronchiolitis has increased in the United States. individual treatment for this disease consists of aerosolized ribavirin, an antiviral agent used for treatment of respiratory syncytial virus infections. Other treatments, geared toward symptom have charge of include bronchodilators and corticosteroids. However, there is little consensus regarding the best treatment strategies, and there is significant variation in treatments. King and associates performed a systematic review of the effectiveness of commonly used treatments for bronchiolitis in infants and children.

The research delineate was a systematic review of the scientific literature. The authors searched MEDLINE and Cochrane Collaboration's Database of Controll Clinical Trials for randomized controll trials of the treatment of bronchiolitis from January 1980 by means of November 2002. Studies had to have a sample size of at least 10 make subordinates to be included in the review. Data extracted from the studies were characteristics of the inquiry population, interventions used, and originates The results were entered into evidence tables and analyzed by means of drug category.

The researchers identified 797 abstracts, of which 44 met the inclusion criteria for the application of mind The studies were divided into the following categories of treatment: eight studies of epinephrine, 13 studies of [beta.sub.2]-agonist bronchodilators, 13 studies of corticosteroids, and 10 studies of ribavirin. most numerous of the studies reviewed were powered insufficiently to find statistically significant outcome differences between the inquiry groups. There were few studies that aggregateed outcomes data on matters important to clinicians and parents, like as the need for hospitalization and duration of stay.

The authors terminate that little evidence supports the routine use of any of these classes of medications in treating infants and children with bronchiolitis. They behold a need for a large, well-designed meditation of the commonly used treatments for bronchiolitis to establish the best protocol for managing this condition.

EDITOR'S NOTE: As we determine further in our attempt to unfold an evidence-based approach to everyday medical problems, some of the antiquated standard therapies are being reassessed, as is the case with the treatment of bronchiolitis. In another inquiry published in the same issue, mess and associates found that nebulized epinephrine and albuterol had similar efficacy in treating moderate bronchiolitis in young children. (1) The meaning for clinicians is that we ne to continue to treat bronchiolitis with the standard medications and realize that eventually our treatment strategies may have to be altered.--K.E.M.

REFERENCE

(1) mess CC, Scarfone RJ, Ferri LR Carlin T Salvaggio C Bechtel KA, et al. A randomized trial of nebulized epinephrine v albuterol in the conjuncture department treatment of bronchiolitis. Arch Pediatr Adolesc M 2004;158:113-8

KARL E MILLER, MD

King VJ et al. Pharmacologic treatment of bronchiolitis in infants and children. A systematic review. Arch Pediatr Adolesc M February 2004;158:127-37

COPYRIGHT 2004 American Academy of Family Physicians

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