Background Airway viruses, most often respiratory syncytial virus, cause acute bronchiolitis. Despite no evidence of its effect, 30–100% of hospitalised children globally receive antibiotics. The aim of the study was to identify the rate of antibiotics use in hospitalised infants with moderate to severe acute bronchiolitis in Norway.
Methods 404 infants hospitalised with moderate to severe acute bronchiolitis in eight centres in Southeast Norway completed a clinical trial of inhaled racemic adrenaline was included in this study. The mean length of stay was 3.3 days, 43.6% received oxygen support, 29.0% nasogastric tube feeding and 7.4% ventilatory support.
Results 8.4% (n = 34) of the patients received systemic antibiotics, (17 intravenous and 17 oral), most commonly penicillin (41%), ampicillin (26%) and gentamicin (24%). Use of antibiotics versus no antibiotics was significantly associated with a longer hospital stay (mean 135.5 h (95% CI 117.0–154.1) vs 65.9 h (95% CI 47.2–85.1), p < 0.001) and use of supportive therapy (all p < 0.03). Patients receiving supportive therapy more often received antibiotics than those without supportive therapy: oxygen (17.4% vs 1.4%, p < 0.001), nasogastric tube feeding (15.5% vs 5.7%, p = 0.03) and ventilation (CPAP) (48.3% vs 5.3%, p < 0.001).
Conclusion The use of antibiotics is substantially lower than previously reported in any geographical region. With length of stay and use of supportive care comparable to other countries, we believe the finding supports a conservative approach in bronchiolitis management.
Skjerven HO, et al. Racemic adrenaline and inhalation strategies in acute bronchiolitis. N Engl J Med, 2013.368(24):p.2286-93