Bronchiolitis

Bronchiolitis:

• Age group: less then 2 year, More common 2-6 month 
  
• Organism:RSV,Influenza,Para influenza,mycoplasma
  

Clinical Features:

• Cough
• Respiratory distress
• Wheeze
• Mild fever

O/E:

• Dyspnea
• cyanosis
• flaring of alae nasi
• Head nodding
• Fast breathing
• chest indrawing
• Auscultaion-hyperresonance

Investigations:

• CBC with CRP
• X-ray chest A/P or P/A view
• Hypertranslucency
• hyperinflation
• horizontal ribs

Rx:

•  Bed rest 
  
• Diet: Normal
• 02 inhallation stat & sos

1.  Nebulization ē Sultolin solution(5mg/ml)- 4-6 hourly

• (0.3/0.4/0.5ml sultolin + 2.7/2.6/2.5 ml N/S)
• 3-5kg = 0.3ml sultolin + 2.7 ml normal saline
• 5-8kg = 0.4ml sultolin + 2.6ml normal saline
• >9kg = 0.5 ml sultolin + 2.5ml normal saline

2. Nebulization with 3% saline(Role three)

• 3ml  X 3 times daily for -3 days 

3. Solo/Norsal Nasal drop

• 2-3 drops প্রতি নাকে দিনে ৩ বার 

If suspect or evidance any secondary infection:

Inj .Tazid (ceftazidime)(250mg/2.5ml)

• wt/2 x 1 ml I/V - BD (100mg/kg/day)

Inj. Kacin (amikacin)(100mg/ 2ml)

• wt x 0.15 ml IV- BD(15mg/kg/day)

>3 months: 

Inj. Oricef (Ceftriaxone)(500mg/5ml)

• wt/2 ml I/V....BD(10mg/kg/day)

If fever:

Syp.Napa (Paracetamol)(120mg/5 ml) 

Dose: 15mg/kg/dose ...3/4 times daily.......3-5 days (if temp present)

• 5-8 kg = 4ml - 5ml 
• 8-11 kg = 5-7ml 
• 12-16 kg= 10 ml /2 TSF 

During Discharge from hospital:

1. Syp.Brodril(sulbutamol)(2mg/5 ml) /Levostar(1mg/5ml)

Dose:0.2-0.4 mg/kg/day.....bd/tds....5 days 

Average dose:

•        6-12 months = 1-2 ml 3 times daily
• 2-6 years: 2.5 ml( ১/২ চামচ)  3-4 times daily
  
• 6-12 years: 5 ml(১চামচ) 3-4 times daily
• Over 12 years: 5-10(১-২চামচ) ml ..3-4 times daily (2-4 mg tablet, 3-4 times daily) 
  

2. Syp.Adryl(Diphenhydramine)  (10mg/5 ml) 

• 6-8 kg = ½ TSF
• 8-11 Kg = 1 TSF
• >11Kg = 1-1 ½ TSF .........5-7 days 

if cough:

Pedi drop Ambrox 

Drop- 6mg/ml

• ০-৬মাস পর্যন্ত→0.5ml (৮ড্রপ) ২বার
• ১-৫বছর পর্যন্ত→1ml (১৫ড্রপ) ২বার
• ৫বছর এর উপরে→1.25ml (২০ড্রপ) ২বার

Solo Nasal drop

• 2-3 drops প্রতি নাকে দিনে ৩ বার... ১৫ দিন

Alternative Antibiotics:

• Amoxicillin(15mg/kg/dose...TDS
• Cotrim(5mg/kg/dose...BD)
• Azithromycin(10-20mg/kg/day...OD)