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Treatment

Note^[1]

Clinicians should administer nasogastric or intravenous fluids for infants with a diagnosis of bronchiolitis who cannot maintain hydration orally
Clinicians should not administer albuterol (or salbutamol) to infants and children with a diagnosis of bronchiolitis.
Clinicians should not administer epinephrine to infants and children with a diagnosis of bronchiolitis.
Clinicians should not administer systemic corticosteroids to infants with a diagnosis of bronchiolitis in any setting.
Clinicians should not administer antibacterial medications to infants and children with a diagnosis of bronchiolitis unless there is a concomitant bacterial infection, or a strong suspicion of one.
Nebulized hypertonic saline should not be administered to infants with a diagnosis of bronchiolitis in the emergency department.
Clinicians should not use chest physiotherapy for infants and children with a diagnosis of bronchiolitis.

Prophylaxis

Regimen: Palivizumab (15 mg/kg/dose) during the respiratory syncytial virus season to infants who qualify for palivizumab in the first year of life.

Note

Clinicians should administer palivizumab during the first year of life to infants with hemodynamically significant heart disease or chronic lung disease of prematurity defined as preterm infants <32 weeks 0 days’ gestation who require >21% oxygen for at least the first 28 days of life.
Clinicians should not administer palivizumab to otherwise healthy infants with a gestational age of 29 weeks, 0 days or greater.
All people should disinfect hands before and after direct contact with patients, after contact with inanimate objects in the direct vicinity of the patient, and after removing gloves.
All people should use alcoholbased rubs for hand decontamination when caring for children with bronchiolitis. When alcoholbased rubs are not available, individuals should wash their hands with soap and water.
Clinicians should counsel caregivers about exposing the infant or child to environmental tobacco smoke and smoking cessation when assessing a child for bronchiolitis.

Treatment

Preferred Regimen(1): Zanamivir 10 mg (two 5-mg inhalations) BID for 5 days.
Preferred Regimen(2): Oseltamivir 75 mg BID for 5 days.
Preferred Regimen(3): Peramivir one 600 mg dose, via intravenous infusion for 15-30 minutes for 1 day.

Prophylaxis

Oseltamivir
If younger than 1 yr old1:
3 mg/kg/dose twice daily2,3
If 1 yr or older, dose varies by child’s weight:
15 kg or less, the dose is 30 mg twice a day
>15 to 23 kg, the dose is 45 mg twice a day>23 to 40 kg, the dose is 60 mg twice a day>40 kg, the dose is 75 mg twice a day.
Zanamivir
10 mg (two 5-mg inhalations) twice daily

(FDA approved and recommended for use in children 7 yrs or older).

Note:

Early treatment of hospitalized patients can reduce death.
An emphasis on close monitoring and early initiation of antiviral treatment if fever and/or respiratory symptoms develop is an alternative to chemoprophylaxis after a suspected exposure for some persons.
The following are examples of situations where antiviral medications can be considered for chemoprophylaxis to prevent influenza:

Prevention of influenza in persons at high risk of influenza complications during the first two weeks following vaccination after exposure to an infectious person.
Prevention for people with severe immune deficiencies or others who might not respond to influenza vaccination, such as persons receiving immunosuppressive medications, after exposure to an infectious person.
Prevention for people at high risk for complications from influenza who cannot receive influenza vaccine due to a contraindication after exposure to an infectious person.
To be effective as chemoprophylaxis, an antiviral medication must be taken each day for the duration of potential exposure to a person with influenza and continued for 7 days after the last known exposure. For persons taking antiviral chemoprophylaxis after inactivated influenza vaccination, the recommended duration is until immunity after vaccination develops (antibody development after vaccination takes about two weeks in adults and can take longer in children depending on age and vaccination history).

Antiviral chemoprophylaxis generally is not recommended if more than 48 hours have elapsed since the first exposure to an infectious person.
Patients receiving antiviral chemoprophylaxis should be encouraged to seek medical evaluation as soon as they develop a febrile respiratory illness that might indicate influenza.
Zanamivir is contraindicated in patients with history of allergy to milk protein.
Oral oseltamivir is preferred for treatment of pregnant women.
For control of outbreaks in institutional settings (e.g. long-term care facilities for elderly persons and children) and hospitals, CDC recommends antiviral chemoprophylaxis for a minimum of 2 weeks, and continuing up to 1 week after the last known case was identified. Antiviral chemoprophylaxis is recommended for all residents, including those who have received influenza vaccination, and for unvaccinated institutional employees.

Dosing in Adult Patients with Renal Impairment

Recommended Treatment Regimen- 30 mg after every hemodialysis cycle. Treatment duration not to exceed 5 days
Recommended Chemoprophylaxis Regimen- 30 mg after alternate hemodialysis cycles.

ESRD Patients on Continuous Ambulatory Peritoneal Dialysis Creatinine clearance ≤10 mL/min.

Recommended Treatment Regimen- A single 30 mg dose administered immediately after a dialysis exchange
Recommended Chemoprophylaxis Regimen- 30 mg once weekly immediately after dialysis exchange
Recommended Chemoprophylaxis Regimen- 30 mg after alternate hemodialysis cycles.

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