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Management of bronchiolitis without antibiotics: a multicentre randomized control trial in Bangladesh
A R M L Kabir1, A H Mollah, K S Anwar
1Department of Paediatrics, Institute of Child and Mother Health (ICMH), Matuail, Dhaka, Bangladesh. edrafed@gmail.com
Insights
Antibiotics do not improve outcomes for infants with bronchiolitis. This study found that children receiving supportive care alone recovered similarly to those given antibiotics, indicating antibiotics are unnecessary for bronchiolitis management.
Area of Science:
- Pediatrics
- Infectious Diseases
- Respiratory Medicine
Background:
- Bronchiolitis is a common viral respiratory infection in infants.
- Antibiotic use for bronchiolitis is controversial, with limited evidence supporting its efficacy.
Purpose of the Study:
- To determine if antibiotics have a role in managing bronchiolitis.
- To compare clinical outcomes of infants with bronchiolitis treated with or without antibiotics.
Main Methods:
- A multicenter randomized controlled trial (RCT) was conducted in Bangladesh.
- Infants under 24 months with bronchiolitis were randomized into three groups: parenteral ampicillin, oral erythromycin, or no antibiotic, alongside supportive care.
- Clinical improvement was assessed using 18 symptoms/signs graded on a recovery scale (rapid/gradual).
Main Results:
- No significant differences in recovery rates were observed between antibiotic and no-antibiotic groups for most chest and non-chest symptoms.
- Nasal symptoms also showed no difference in recovery among the groups.
- Children managed with supportive measures alone had similar clinical outcomes to those receiving antibiotics.
Conclusions:
- Supportive care without antibiotics is the preferred management strategy for bronchiolitis in hospital settings.
- Antibiotic administration does not alter the clinical course or outcome of bronchiolitis.
Objective:
To ascertain that antibiotics have no role in the management of bronchiolitis.
Design:
Multicentre randomized control trial (RCT).
Setting:
Five purposively selected teaching hospitals in Bangladesh.
Patient:
Children under 24 months old with bronchiolitis.
Interventions:
Children were randomized into three groups of therapeutic interventions: parenteral ampicillin (P-Ab), oral erythromycin (O-Ab) and no antibiotic (N-Ab) in adjunct to supportive measures.
Main Outcome Measures:
Clinical improvement was assessed using 18 symptoms/signs which were graded on a two-point recovery scale of 'rapid' and 'gradual', indicating improvement within 'four days' and 'beyond four days', respectively.
Results:
Each intervention group consisted of 98 +/- 1 children having comparable clinico-epidemiological characteristics at the baseline. The trial revealed that most chesty features (features appearing to arise from chest, i.e. cough, breathing difficulty, wheeze, chest indrawing, tachypnoea, tachycardia, rhonchi and crepitation) demonstrated a gradual recovery, beyond 4th admission day and, not differing among the three intervention groups (p > 0.23, p < 0.62, p = 0.54, p < 0.27, p = 0.75, p = 0.76, p = 0.81, p > 0.98, respectively). Most non-chesty features (features appearing to arise away from chest, i.e. feeding/sleeping difficulties, social smile, restlessness, inconsolable crying, nasal flaring, fever and hypoxaemia) demonstrated a rapid recovery, within 4 days, remaining comparable among the three intervention groups (p < 0.07, p = 0.65, p = 0.24, p < 0.61, p = 0.22, p = 0.84, p = 0.29 and p = 0.96, respectively). However, nasal symptoms (runny nose and nasal blockage) also showed no difference among groups (p = 0.36 and p = 0.66, respectively). Thus, the dynamics of clinical outcome obviates that children not receiving antibiotics had similar clinical outcome than those who did.
Conclusion:
In hospital settings, managing bronchiolitis with only supportive measures but without antibiotics remains preferable.
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