Medication and nasal suction

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Medication and nasal suction

Beta2 agonists

Do not use beta2 agonists in infants (<12 months of age) presenting or admitted to hospital with bronchiolitis. (Evidence quality: moderate; recommendation strength: strong)

Do not use beta2 agonists in infants (<12 months of age), presenting or admitted to hospital with bronchiolitis with a personal or family history of atopy, outside of a randomised controlled trial (RCT). (Evidence quality: very low; recommendation strength: strong)

Adrenaline/epinephrine

Do not use adrenaline/epinephrine in infants presenting or admitted to hospital with bronchiolitis. (Evidence quality: low; recommendation strength: strong)*

*Refer to the ‘Combined corticosteroid and adrenaline/epinephrine’ therapy section below for guidance.

Glucocorticoids

Do not use glucocorticoids (systemic or local) in infants with bronchiolitis*. (Evidence quality: low; recommendation strength: strong)

*For guidance on the use of glucocorticoids when SARS-CoV-2 infection is present, refer to ‘Treatment of SARS-CoV-2 co-infection’ on below.

Do not use glucocorticoids for the routine treatment of infants with bronchiolitis and a positive response to beta2 agonists or other markers of a latter asthmatic phenotype outside of an RCT. Beta2 agonists should not be used in infants <12 months of age. (Evidence quality: NA; recommendation strength: strong)

Combined corticosteroid and adrenaline/epinephrine therapy

Do not routinely use a combination of systemic or local corticosteroids and adrenaline/epinephrine in infants presenting or admitted to hospital with moderate bronchiolitis outside of the ICU setting (evidence quality: moderate; recommendation strength: conditional). 

A combination of systemic or local corticosteroids and adrenaline/epinephrine may be considered in infants with severe bronchiolitis requiring ICU level care. (Evidence quality: moderate; recommendation strength: conditional)

Hypertonic saline

Do not routinely use nebulised hypertonic saline in infants presenting or admitted to hospital with bronchiolitis outside of an RCT. (Evidence quality: low; recommendation strength: weak)

Antibiotic medication

Do not routinely use antibiotic medication for the treatment of infants with bronchiolitis. (Evidence quality: very low; recommendation strength: conditional)

Do not routinely use azithromycin for the treatment of bronchiolitis in infants admitted to hospital. (Evidence quality: low; recommendation strength: weak)

Additionally, do not routinely use antibiotics for the treatment of bronchiolitis in infants at risk of developing bronchiectasis due to known risk factors such as virus type (e.g., Adenovirus), Indigenous ethnicity, or socioeconomic disadvantage. (Evidence quality: very low; recommendation strength: weak)

Treatment of SARS-CoV-2 co-infection

For hypoxaemic infants with bronchiolitis and SARS-CoV-2 infection, consider use of dexamethasone. (Evidence quality: NA; recommendation strength: consensus-based)

For immunosuppressed infants with bronchiolitis and SARS-CoV-2 infection, consider use of remdesivir. (Evidence quality: NA; recommendation strength: consensus-based)

Nasal suction

Do not routinely use nasal suction in the management of infants with bronchiolitis. (Evidence quality: low; recommendation strength: conditional)

However, superficial suctioning may be considered in infants with respiratory distress or feeding difficulties from upper airway secretions. (Evidence quality: low; recommendation strength: conditional). Superficial suctioning refers to suctioning of the nose. 

Additionally, one off suctioning may be performed prior to oxygen supplementation to increase patient comfort and avoid clogging of nasal prongs.

Do not routinely use deep nasal suctioning for the management of infants with bronchiolitis. (Evidence quality: low; recommendation strength: weak). Deep suctioning refers to any suctioning beyond the nose, such as the nasopharynx.

Nasal saline

Do not routinely use nasal saline drops in the management of infants with bronchiolitis. (Evidence quality: very low; recommendation strength: conditional)

A trial of intermittent nasal saline drops could be considered at the time of feeding in infants with reduced feeding. (Evidence quality: very low; recommendation strength: conditional)