Management of bronchiolitis without antibiotics: a multicentre randomized control trial in Bangladesh.
OBJECTIVE
To ascertain that antibiotics have no role in the management of bronchiolitis.


METHODS
Multicentre randomized control trial (RCT).


METHODS
Five purposively selected teaching hospitals in Bangladesh.


METHODS
Children under 24 months old with bronchiolitis.


METHODS
Children were randomized into three groups of therapeutic interventions: parenteral ampicillin (P-Ab), oral erythromycin (O-Ab) and no antibiotic (N-Ab) in adjunct to supportive measures.


METHODS
Clinical improvement was assessed using 18 symptoms/signs which were graded on a two-point recovery scale of 'rapid' and 'gradual', indicating improvement within 'four days' and 'beyond four days', respectively.


RESULTS
Each intervention group consisted of 98 +/- 1 children having comparable clinico-epidemiological characteristics at the baseline. The trial revealed that most chesty features (features appearing to arise from chest, i.e. cough, breathing difficulty, wheeze, chest indrawing, tachypnoea, tachycardia, rhonchi and crepitation) demonstrated a gradual recovery, beyond 4th admission day and, not differing among the three intervention groups (p > 0.23, p < 0.62, p = 0.54, p < 0.27, p = 0.75, p = 0.76, p = 0.81, p > 0.98, respectively). Most non-chesty features (features appearing to arise away from chest, i.e. feeding/sleeping difficulties, social smile, restlessness, inconsolable crying, nasal flaring, fever and hypoxaemia) demonstrated a rapid recovery, within 4 days, remaining comparable among the three intervention groups (p < 0.07, p = 0.65, p = 0.24, p < 0.61, p = 0.22, p = 0.84, p = 0.29 and p = 0.96, respectively). However, nasal symptoms (runny nose and nasal blockage) also showed no difference among groups (p = 0.36 and p = 0.66, respectively). Thus, the dynamics of clinical outcome obviates that children not receiving antibiotics had similar clinical outcome than those who did.


CONCLUSIONS
In hospital settings, managing bronchiolitis with only supportive measures but without antibiotics remains preferable.
Kabir
A R M L
AR
Department of Paediatrics, Institute of Child and Mother Health (ICMH), Matuail, Dhaka, Bangladesh. edrafed@gmail.com
Mollah
A H
AH
Anwar
K S
KS
Rahman
A K M F
AK
Amin
R
R
Rahman
M E
ME
D017677:Age Distribution; D000667:Ampicillin / Q000627:therapeutic use*; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001459:Bangladesh; D001988:Bronchiolitis / Q000188:drug therapy / Q000628:therapy*; D016009:Chi-Square Distribution; D004917:Erythromycin / Q000627:therapeutic use*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007223:Infant; D008297:Male; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D004917:Erythromycin; D000667:Ampicillin