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- Bronchodilators (albuterol, epinephrine)
- Dosing:
- Albuterol: 0.5% solution, 0.15-0.3 mg in 3 mL normal saline via nebulizer every 2-4 hours as needed
- Racemic epinephrine: 0.25-0.5 mL of 2.25% racemic epinephrine (max 5 mL) in 3 mL normal saline via nebulizer every 20 minutes for up to 3 doses
- Limited proven efficacy in RSV bronchiolitis
- Not routinely recommended
- May trial in severe cases but discontinue if no benefit
- Dosing:
- Ribavirin
- Dosing:
- 12-18 hours/day for 3-7 days
- Antiviral agent delivered via aerosol generator
- No proven efficacyNot used routinely
- Costly and cumbersome to administer
- Dosing:
- Palivizumab
- Dosing:
- 15 mg/kg IM monthly during RSV season
- Reduces hospitalization by 50% in high-risk infants
- Given to premature infants and those with lung/heart disease or immunodeficiencies
- High cost limits widespread use
- Dosing:
- Systemic & inhaled corticosteroids (dexamethasone)
- Dosing:
- Dexamethasone 0.15-0.6 mg/kg/dose PO/IV daily for up to 10 days
- Not beneficial in bronchiolitis
- Associated with prolonged viral shedding
- Should not be used routinely
- Dosing:
- Antibiotics
- Do not treat RSV infection
- Reserve for secondary bacterial infections
- Overuse promotes antibiotic resistance