Blackford MG, Glover ML, Reed MD. Lower Respiratory Tract Infections.
In: DiPiro, JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM.
Pharmacotherapy: A Pathophysiologic Approach. 8th edition. http://www.accesspharmacy.com/content.aspx?aid=8001618.
Accessed July 12, 2012.
- Acute viral infection of lower respiratory tract of infants
that affects ~50% of children during first year of life
and 100% by 3 years.
- Most common cause: respiratory syncytial virus (RSV)
- Other: parainfluenza viruses
- Bacteria are secondary pathogens in minority of cases.
- Viral or bacterial invasion of lung parenchyma
- Occurrence peaks during winter months and persists through
- Major reason for hospital admission during first year of life.
- More common in males than females.
- RSV prophylaxis in infants with underlying pulmonary or
- Monthly administration during RSV season
- Prodrome suggesting an upper respiratory tract infection,
usually lasting 2–8 days, precedes onset of clinical symptoms.
- Prodrome with irritability, restlessness, and mild fever
- Noisy breathing
- Increase in respiratory rate
- Labored breathing with retractions of chest wall, nasal flaring,
Means of Confirmation
- History and physical exam
and increased respiratory rate
- Wheezing and inspiratory rales
- Mild conjunctivitis in one-third of patients
- Otitis media in 5–10% of patients
- Complete blood count (CBC): White blood cell (WBC) count
normal or slightly elevated.
- Arterial blood gases
- Culture of respiratory secretions: Establishes presumptive
diagnosis of infectious bronchiolitis.
- Chest radiograph to distinguish between illnesses characterized
- Resolution of signs and symptoms
- Self-limiting illness usually requiring no therapy unless
infant hypoxic or dehydrated.
- Otherwise healthy infants:
- Severe cases:
- Antibiotics not routinely administered, but may be used
until culture results available.
- Ribavirin if caused by RSV in patients with underlying pulmonary
or cardiac disease, or with severe acute infection
- Infants with underlying pulmonary or cardiovascular disease
- RSV prophylaxis
- Monthly administration
during RSV season
- RSV immune globulin
- Assess for resolution of symptoms.
- Self-limited disease in otherwise healthy infant
- Hospitalization may be necessary if child has underlying cardiac
or pulmonary disease.