Adult bronchiolitis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]

Overview

The optimal medical therapy for adult bronchiolitis is unknown. Therapy is mainly the cessation of exposure to irritant agent. Bronchiolitis is treated based on severity, however, the disease is progressive and inevitably, leads to respiratory failure. Therefore, supportive therapy includes supplemental oxygen, bronchodilators, cough suppressant, anti-reflux therapy, antibiotic macrolides and glucocorticoids. Bronchodilators have been heavily criticized in their role of improving symptoms, and are reserved only in those who show clinical improvement.

Medical Therapy

• The optimal medical therapy for adult bronchiolitis is unknown.
• Therapy is mainly the cessation of exposure to irritant agent.
• Bronchiolitis is treated based on severity, however, the disease is progressive and inevitably, leads to respiratory failure.
• Therefore, supportive therapy includes supplemental oxygen, bronchodilators, cough suppressant, anti-reflux therapy, antibiotic macrolides and glucocorticoids.
• Bronchodilators have been heavily criticized in their role of improving symptoms, and are reserved only in those who show clinical improvement.

Adult bronchiolitis

• 1 Stage 1 - Respiratory compromise
  • 1.1 Supplemental oxygen
    • 1.1.1 Adult
      • Preferred regimen (1): maintain oxygen saturation at higher than 90% for 24 hours on standard flow rate
      • Preferred regimen (2): maintain oxygen saturation at higher than 90% for 20 hours on high flow humidified oxygen
      • Preferred regimen (3): maintain oxygen saturation at higher than 90% for 24 hours using Heliox (20 - 30% oxygen and 70 - 80% helium)
  • 1.2 Antibiotic macrolide
    • 1.1.2 Adult
      • Preferred regimen (1): Erythromycin 200 - 600 day) or clarithromycin (250 or 500 mg/day).
      • Preferred regimen (2): drug name 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
      • Alternative regimen (1): drug name10 mg/kg PO q6h (maximum, 500 mg per day)
      • Alternative regimen (2): drug name 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
      • Alternative regimen (3): drug name 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
    • 1.1.2.2 (Specific population e.g. 'children < 8 years of age')
      • Preferred regimen (1): drug name 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
      • Alternative regimen (1): drug name 10 mg/kg PO q6h (maximum, 500 mg per day)
      • Alternative regimen (2): drug name 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
      • Alternative regimen (3): drug name 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
  • 1.2 Specific Organ system involved 2
    • 1.2.1 Adult
      • Preferred regimen (1): drug name 500 mg PO q8h
    • 1.2.2 Pediatric
      • Preferred regimen (1): drug name 50 mg/kg/day PO q8h (maximum, 500 mg per dose)

• 2 Stage 2 - Name of stage
  • 2.1 Specific Organ system involved 1

    Note (1):

    Note (2):

    Note (3):

    • 2.1.1 Adult
      • Parenteral regimen
        • Preferred regimen (1): drug name 2 g IV q24h for 14 (14–21) days
        • Alternative regimen (1): drug name 2 g IV q8h for 14 (14–21) days
        • Alternative regimen (2): drug name 18–24 MU/day IV q4h for 14 (14–21) days
      • Oral regimen
        • Preferred regimen (1): drug name 500 mg PO q8h for 14 (14–21) days
        • Preferred regimen (2): drug name 100 mg PO q12h for 14 (14–21) days
        • Preferred regimen (3): drug name 500 mg PO q12h for 14 (14–21) days
        • Alternative regimen (1): drug name 500 mg PO q6h for 7–10 days
        • Alternative regimen (2): drug name 500 mg PO q12h for 14–21 days
        • Alternative regimen (3):drug name 500 mg PO q6h for 14–21 days
    • 2.1.2 Pediatric
      • Parenteral regimen
        • Preferred regimen (1): drug name 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
        • Alternative regimen (1): drug name 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
        • Alternative regimen (2):  drug name 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) '(Contraindications/specific instructions)'
      • Oral regimen
        • Preferred regimen (1): drug name 50 mg/kg/day PO q8h for 14 (14–21) days (maximum, 500 mg per dose)
        • Preferred regimen (2): drug name (for children aged ≥ 8 years) 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
        • Preferred regimen (3): drug name 30 mg/kg/day PO q12h for 14 (14–21) days (maximum, 500 mg per dose)
        • Alternative regimen (1): drug name 10 mg/kg PO q6h 7–10 days (maximum, 500 mg per day)
        • Alternative regimen (2): drug name 7.5 mg/kg PO q12h for 14–21 days (maximum, 500 mg per dose)
        • Alternative regimen (3): drug name 12.5 mg/kg PO q6h for 14–21 days (maximum,500 mg per dose)
  • 2.2 'Other Organ system involved 2'

    Note (1):

    Note (2):

    Note (3):

    • 2.2.1 Adult
      • Parenteral regimen
        • Preferred regimen (1): drug name 2 g IV q24h for 14 (14–21) days
        • Alternative regimen (1): drug name 2 g IV q8h for 14 (14–21) days
        • Alternative regimen (2): drug name 18–24 MU/day IV q4h for 14 (14–21) days
      • Oral regimen
        • Preferred regimen (1): drug name 500 mg PO q8h for 14 (14–21) days
        • Preferred regimen (2): drug name 100 mg PO q12h for 14 (14–21) days
        • Preferred regimen (3): drug name 500 mg PO q12h for 14 (14–21) days
        • Alternative regimen (1): drug name 500 mg PO q6h for 7–10 days
        • Alternative regimen (2): drug name 500 mg PO q12h for 14–21 days
        • Alternative regimen (3):drug name 500 mg PO q6h for 14–21 days
    • 2.2.2 Pediatric
      • Parenteral regimen
        • Preferred regimen (1): drug name 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
        • Alternative regimen (1): drug name 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
        • Alternative regimen (2):  drug name 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
      • Oral regimen
        • Preferred regimen (1): drug name 50 mg/kg/day PO q8h for 14 (14–21) days (maximum, 500 mg per dose)
        • Preferred regimen (2): drug name 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
        • Preferred regimen (3): drug name 30 mg/kg/day PO q12h for 14 (14–21) days (maximum, 500 mg per dose)
        • Alternative regimen (1): drug name 10 mg/kg PO q6h 7–10 days (maximum, 500 mg per day)
        • Alternative regimen (2): drug name 7.5 mg/kg PO q12h for 14–21 days (maximum, 500 mg per dose)
        • Alternative regimen (3): drug name 12.5 mg/kg PO q6h for 14–21 days (maximum,500 mg per dose)