Adult bronchiolitis medical therapy: Difference between revisions

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==Overview==
==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.
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, immunosuppressants 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==
==Medical Therapy==
Line 10: Line 10:
*Therapy is mainly the cessation of exposure to irritant agent.  
*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.  
*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.
*Therefore, supportive therapy includes supplemental oxygen, bronchodilators, cough suppressant, anti-reflux therapy, antibiotic macrolides, immunosuppressants and glucocorticoids.
*Bronchodilators have been heavily criticized in their role of improving symptoms, and are reserved only in those who show clinical improvement.
*Bronchodilators have been heavily criticized in their role of improving symptoms, and are reserved only in those who show clinical improvement.


Line 24: Line 24:
** 1.2 '''Antibiotic macrolide'''
** 1.2 '''Antibiotic macrolide'''
*** 1.1.2 Adult
*** 1.1.2 Adult
**** Preferred regimen (1): Erythromycin 200 - 600  day) or clarithromycin (250 or 500 mg/day).  
**** Preferred regimen (1): Erythromycin 200 - 600mg PO per day   
**** Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
**** Preferred regimen (2): Clarithromycin 250 - 500mg PO per day
**** Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)
***1.1.3 Bronchiolitis obliterans syndrome
**** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
**** Preferred regimen (1): Azithromycin 250 mg daily for 5 days followed by 250 mg 3 times a week
**** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
***1.1.2.2 (Specific population e.g. '<nowiki/>'''''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) '<nowiki/>'''''(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  '<nowiki/>'''''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)




Revision as of 16:52, 3 March 2018

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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, immunosuppressants 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, immunosuppressants 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


References

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