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Review shows substantial variations in the use of medication for infant bronchiolitis between and within countries
Matti Korppi1, Minna Mecklin1, Paula Heikkilä1
1Center for Child health Research, Tampere University Hospital, University of Tampere, Tampere, Finland.
Insights
Medication use for infant bronchiolitis varies significantly worldwide, despite evidence not supporting its effectiveness. This review highlights inconsistent real-world treatment practices in hospitals globally.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Evidence-Based Medicine
Background:
- Randomized controlled trials indicate no benefit from medication for infant bronchiolitis.
- Real-world medication use in hospitalized infants with bronchiolitis remains under-examined.
Purpose of the Study:
- To summarize current data on the real-life use of medications for infants hospitalized with bronchiolitis.
- To evaluate variations in medication administration across different healthcare settings and countries.
Main Methods:
- A systematic literature search was conducted on PubMed for studies published between 2009 and 2018.
- Studies focusing on the use of adrenaline, salbutamol, corticosteroids, or antibiotics in infants hospitalized for bronchiolitis were included.
Main Results:
- Ten studies revealed significant international and intranational variations in medication use for infant bronchiolitis.
- A multi-center study reported that 29% of infants received non-evidence-based drugs, with rates varying from 9% to 58% across countries.
- In US pediatric intensive care units (PICUs), bronchodilators were used in 60%, corticosteroids in 33%, and antibiotics in 63% of cases.
Conclusions:
- Substantial variations exist in the treatment of infant bronchiolitis, both between and within different countries.
- Current real-world practices often deviate from evidence-based recommendations for infant bronchiolitis management.
Aim:
Meta-analyses of randomised controlled trials on infant bronchiolitis do not support medication. We summarised the current data and evaluated the real-life use of medication for infants treated for bronchiolitis in hospitals, including paediatric wards, emergency departments and paediatric intensive care units (PICU).
Methods:
We searched PubMed for studies published from 2009 to 2018 that provided data on the real-life use of adrenaline, salbutamol, corticosteroids or antibiotics for infants hospitalised for bronchiolitis.
Results:
The review identified 10 such studies and showed substantial variations in medication for infant bronchiolitis between different countries and even between different hospitals in the same country. A multi-centre study including 38 hospitals in eight countries reported that a mean of 29% infants admitted for bronchiolitis received drugs without any research-based evidence on their effectiveness, ranging from 9% in Australia and New Zealand to 58% in Spain and Portugal. In addition, an American prospective multi-centre study of 16 PICUs reported that bronchodilators were used by a mean of 60%, corticosteroids by 33% and antibiotics by 63%. Other studies reported that higher ages and a history of wheezing increased the use of medication.
Conclusion:
There were substantial variations in bronchiolitis treatment between, and within, different countries.
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