Antibiotic treatment of epidemic bronchiolitis--a double-blind trial.

Field, C. M. B.; Connolly, Johnny; Murtagh, Gillian; Slattery, Claire M.; Turkington, E. E.

doi:10.1136/bmj.1.5479.83

Cited by 60 publications

(24 citation statements)

References 11 publications

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“…105 Early RCTs 106,107 showed no benefit from antibacterial treatment of bronchiolitis. However, concern remains regarding the possibility of bacterial infections in young infants with bronchiolitis; thus, antibacterial agents continue to be used.…”

Section: Evidence Profile 4: Ribavirinmentioning

confidence: 99%

Diagnosis and Management of Bronchiolitis

2006

Pediatrics

885

293

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Bronchiolitis is a disorder most commonly caused in infants by viral lower respiratory tract infection. It is the most common lower respiratory infection in this age group. It is characterized by acute inflammation, edema, and necrosis of epithelial cells lining small airways, increased mucus production, and bronchospasm.The American Academy of Pediatrics convened a committee composed of primary care physicians and specialists in the fields of pulmonology, infectious disease, emergency medicine, epidemiology, and medical informatics. The committee partnered with the Agency for Healthcare Research and Quality and the RTI International-University of North Carolina Evidence-Based Practice Center to develop a comprehensive review of the evidence-based literature related to the diagnosis, management, and prevention of bronchiolitis. The resulting evidence report and other sources of data were used to formulate clinical practice guideline recommendations.This guideline addresses the diagnosis of bronchiolitis as well as various therapeutic interventions including bronchodilators, corticosteroids, antiviral and antibacterial agents, hydration, chest physiotherapy, and oxygen. Recommendations are made for prevention of respiratory syncytial virus infection with palivizumab and the control of nosocomial spread of infection. Decisions were made on the basis of a systematic grading of the quality of evidence and strength of recommendation. The clinical practice guideline underwent comprehensive peer review before it was approved by the American Academy of Pediatrics.This clinical practice guideline is not intended as a sole source of guidance in the management of children with bronchiolitis. Rather, it is intended to assist clinicians in decision-making. It is not intended to replace clinical judgment or establish a protocol for the care of all children with this condition. These recommendations may not provide the only appropriate approach to the management of children with bronchiolitis. INTRODUCTIONTHIS GUIDELINE EXAMINES the published evidence on diagnosis and acute management of the child with bronchiolitis in both outpatient and hospital settings, including the roles of supportive therapy, oxygen, bronchodilators, antiinflammatory agents, antibacterial agents, and antiviral agents and make recommendations to influence clinician behavior on the basis of the evidence. Methods of prevention All clinical practice guidelines from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.The recommendations in this guideline do not indicate an exclusive course of treatment or serve as a standard of care. Variations, taking into account individual circumstances, may be appropriate. Key Word bronchiolitisAbbreviations CAM-complementary and alternative medicine LRTI-lower respiratory tract infection AHRQ-Agency for Healthcare Research and Quality RSV-respiratory syncytial virus AAP-American Academy of Pediatrics AAFP-American Academy...

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Section: Evidence Profile 4: Ribavirinmentioning

confidence: 99%

Diagnosis and Management of Bronchiolitis

2006

Pediatrics

885

293

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“…Based on signs of clinical deterioration during admission Hall et al [2] found only 1.2 %, while studies using antibody increase in serum or antigen detection in serum or urine find an incidence of up to 44 % [3,4]. Two randomized controlled studies have evaluated the efficacy of antibiotics in patients with RSV-LRTI and found that antibiotics are not beneficial [5,6]. However, these studies not only excluded patients requiring mechanical ventilation but also had a number of methodological problems.…”

mentioning

confidence: 99%

Antibiotic use in pediatric intensive care patients with lower respiratory tract infection due to respiratory syncytial virus

et al. 2001

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“…One other study found mixed results for the effects of antibiotics on wheeze, but did not identify any difference for other symptom measures (Mazumder et al, 2009). Four included studies did not find any difference between antibiotics and placebo for their primary outcomes of length of illness (Field et al, 1966) or lengt of hospital stay (Kabir et al, 2009;Kneyber et al, 2008;Mazumder et al, 2009). Despite these results, antibiotics are commonly used in 34% to 99% of hospitalized infants, even in those that do not require mechanical ventilation (Kabir et al, 2003;Vogel et al, 2003).…”

Section: Antibioticsmentioning

confidence: 99%