Study: Antibiotics May Help Some Youngsters With Bronchiolitis Get Better Faster

A lung infection called bronchiolitis is the most common reason young children get admitted to the hospital. A research team led by doctors at UH Rainbow has reported new findings that may help doctors take care of the sickest children with this common illness.

Bronchiolitis affects children younger than age 2 and is caused by a virus. It results in inflammation and congestion in the small air passages of the lung. Bronchiolitis starts out with symptoms similar to a common cold, but then progresses to coughing, wheezing and sometimes difficulty breathing. Symptoms typically last for several days, though can last longer.

Bronchiolitis is different from bronchitis. While both are lung infections, bronchitis can affect people of all ages, but is most common in older children and adults and involves the trachea and upper bronchial tubes.

Most children with bronchiolitis get better with care at home. But a very small percentage of children require hospitalization – often in a pediatric intensive care unit, where the sickest patients require a machine called a ventilator to assist in breathing.

The Role of Antibiotics

The study’s results, published recently in the journal Pediatric Critical Care Medicine, could result in these patients starting to breathe on their own faster– and help them to get home sooner.

The researchers found that children who received antibiotics during the first two days of assisted breathing needed the machines for 1.2 days less, on average, than those who did not.

Also, these patients stayed at the hospital an average of two days less than the patients who did not receive antibiotics.

To reach their conclusions, the team reviewed data from the Pediatric Health Information System involving 2,107 pediatric patients under age 2 who were treated for severe bronchiolitis in a pediatric intensive care unit in 46 children’s hospitals across the United States.

In addition to UH Rainbow, the research team included investigators from the University of Alabama at Birmingham and Boston Children’s Hospital/Harvard Medical School.

Helping Children Get Home Faster

“The findings may point to an important opportunity for physicians to improve quality of care for these young patients,” says Steven L. Shein, MD, a specialist in pediatric critical care medicine and Chief of the Division of Pediatric Critical Care at UH Rainbow Babies & Children’s Hospital. Dr. Shein presented these findings at the 2019 Society of Critical Care Medicine Congress in San Diego.

“It is important to realize that most children with bronchiolitis will not benefit from receiving antibiotics, since bronchiolitis is caused by a virus,” Dr. Shein says. “Our study suggests that many of the children who are sick enough to require care in the ICU and a breathing tube also have a bacterial infection, and that antibiotics should be used in these cases.

“In this time of increased antibiotic resistance due to overuse, physicians need to clearly understand the risk vs. benefit in using these medicines,” Dr. Shein says. “This study helps to clarify that.

“If we can shorten the time a child has to spend on a ventilator and in the hospital, there is a less of a chance the child may develop a lung injury or further infection. The faster we can get the patient healthy and back home, the better.”

Related links

UH Rainbow's Division of Pediatric Critical Care