Continuing Medical Education

Acute viral bronchiolitis in South Africa: Strategies for management and prevention

Heather J Zar, Shabir A Madhi, Debbie A White, Refiloe Masekela, Samuel Risenga, Humphrey Lewis, Charles Feldman, Brenda Morrow, Prakash Jeena

Abstract


Management of acute viral bronchiolitis is largely supportive. There is currently no proven effective therapy other than oxygen for hypoxic
children. The evidence indicates that there is no routine benefit from inhaled, rapid short-acting bronchodilators, adrenaline or ipratropium
bromide for children with acute viral bronchiolitis. Likewise, there is no demonstrated benefit from routine use of inhaled or oral corticosteroids,
inhaled hypertonic saline nebulisation, montelukast or antibiotics. The last should be reserved for children with severe disease, when bacterial
co-infection is suspected.
Prevention of respiratory syncytial virus (RSV) disease remains a challenge. A specific RSV monoclonal antibody, palivizumab,
administered as an intramuscular injection, is available for children at risk of severe bronchiolitis, including premature infants, young
children with chronic lung disease, immunodeficiency, or haemodynamically significant congenital heart disease. Prophylaxis should be
commenced at the start of the RSV season and given monthly during the season. The development of an RSV vaccine may offer a more
effective alternative to prevent disease, for which the results of clinical trials are awaited.
Education of parents or caregivers and healthcare workers about diagnostic and management strategies should include the following:
bronchiolitis
is caused by a virus; it is seasonal; it may start as an upper respiratory tract infection with low-grade fever; symptoms are
cough and wheeze, often with fast breathing; antibiotics are generally not needed; and the condition is usually self limiting, although
symptoms may occur for up to four weeks in some children.


Authors' affiliations

Heather J Zar, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, and MRC Unit on Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, South Africa

Shabir A Madhi, Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa

Debbie A White, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

Refiloe Masekela, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

Samuel Risenga, Department of Pulmonology, Faculty of Health Sciences, University of Limpopo, Polokwane, and Pietersburg Hospital, South Africa

Humphrey Lewis, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Pretoria, South Africa

Charles Feldman, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

Brenda Morrow, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, South Africa

Prakash Jeena, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

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Keywords

Acute viral bronchiolitis; Management; Prevention

Cite this article

South African Medical Journal 2016;106(4):330-332. DOI:10.7196/SAMJ.2016.v106i4.10437

Article History

Date submitted: 2015-12-08
Date published: 2016-03-03

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