Management of Bronchiolitis with or without Antibiotics – A Randomized Control Trial

Abstract

Background: There has been epidemics of bronchiolitis in the recent years in Bangladesh. Bronchiolitis is mostly (95%) a viral disease in infants and young children but being treated with antibiotics in 99% of cases in our situation. Antibiotic has little role in the management of bronchiolitis. Very few randomized control trials without antibiotics in the management of bronchiolitis have so far been done. Objectives: To evaluate the outcome of bronchiolitis with or without antibiotics in a hospital setting. Methods: A randomized control trial was done during one winter season of 2005 with all cases of bronchiolitis attending a teaching hospital of Dhaka, Bangladesh. Sample size was selected conveniently. One hundred twenty six consecutive cases (one month up to 2 years) with clinical bronchiolitis (runny nose followed by wheeze, cough, breathing difficulty perceived by caregiver, chest indrawing and rhonchi on auscultation) who attended the hospital were enrolled in the study. Detailed history and clinical examination were done and the children were randomized into 3 groups: (1) parenteral antibiotic group, paren AB (30) treated with supportive management and IV ampicillin, (2) oral antibiotic group, oral AB (33) treated with supportive management and oral erythromycin and (3) no antibiotic group, no AB (63) treated with supportive management only. The children were managed both in indoor and outdoor but very sick patients particularly those having oxygen saturation 50/m), hypoxia (oxygen saturation 50/m) at the time of inclusion into the study. The decrement of fast breathing was gradual and similar in all the groups and on day five only about 10% children had fast breathing and it was equal in all the groups (p0.05). About 54% children had hypoxia during inclusion in all the groups (p0.49). The improvement of hypoxia was rapid and similar in all the groups and on day-5 only 6.7% had hypoxia. Hundred percent children of all groups had wheeze at the beginning of the study. The decrement of wheeze was gradual and similar in all groups. On day five total 15% children had wheeze and it was almost equal in all the groups (p0.82 ). The decrement of crepitations in all the groups was also gradual. During inclusion into the study about 60% children had crepitations and it was almost equal in all the groups and on day five about 14% children had crepitations in all the groups (p0.97). Conclusion: The recovery of bronchiolitis managed with supportive therapy alone was found similar to those treated with combined supportive therapy and antibiotics (either oral or parenteral). DOI: 10.3329/jbcps.v27i2.4248 J Bangladesh Coll Phys Surg 2009; 27: 63-69