Pharmacologic treatment of bronchiolitis in infants and children: a systematic review.
BACKGROUND
Bronchiolitis is the most common lower respiratory tract infection in infants. Up to 3% of all children in their first year of life are hospitalized with bronchiolitis. Bronchodilators and corticosteroids are commonly used treatments, but little consensus exists about optimal management strategies.


OBJECTIVE
To conduct a systematic review of the effectiveness of commonly used treatments for bronchiolitis in infants and children.


METHODS
We searched MEDLINE and the Cochrane Controlled Trials Register for references to randomized controlled trials of bronchiolitis treatment published since 1980.


METHODS
Randomized controlled trials of interventions for bronchiolitis in infants and children were included if they were published in English between 1980 and November 2002 and had a minimum sample size of 10.


METHODS
We abstracted data on characteristics of the study population, interventions used, and results of studies meeting entry criteria into evidence tables and analyzed them by drug category.


RESULTS
Interventions were grouped by drug category and qualitatively synthesized.


RESULTS
Of 797 abstracts identified in the literature search, we included 54 randomized controlled trials. This review includes 44 studies of the most common interventions: epinephrine (n = 8), beta2-agonist bronchodilators (n = 13), corticosteroids (n = 13), and ribavirin (n = 10). Studies were, in general, underpowered to detect statistically significant outcome differences between study groups. Few studies collected data on outcomes that are of great importance to parents and clinicians, such as the need for and duration of hospitalization.


CONCLUSIONS
Overall, little evidence supports a routine role for any of these drugs in treating patients with bronchiolitis. A sufficiently large, well-designed pragmatic trial of the commonly used interventions for bronchiolitis is needed to determine the most effective treatment strategies for managing this condition.
King
Valerie J
VJ
Cecil B. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Airport Road, Campus Box 7590, Chapel Hill, NC 27599-7595, USA.
Viswanathan
Meera
M
Bordley
W Clayton
WC
Jackman
Anne M
AM
Sutton
Sonya F
SF
Lohr
Kathleen N
KN
Carey
Timothy S
TS
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use*; D001988:Bronchiolitis / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004837:Epinephrine / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016032:Randomized Controlled Trials as Topic; D012254:Ribavirin / Q000627:therapeutic use
D000305:Adrenal Cortex Hormones; D000998:Antiviral Agents; D001993:Bronchodilator Agents; D012254:Ribavirin; D004837:Epinephrine