Bronchiolitis is a common respiratory infection primarily affecting infants and young children, typically under two years of age. It involves inflammation and swelling of the smallest airways (bronchioles), leading to mucus buildup and difficult breathing. This article clarifies why antibiotics are generally not used in its treatment.
Bronchiolitis is a Viral Infection
Bronchiolitis is caused by viral pathogens, with Respiratory Syncytial Virus (RSV) being the most common culprit, responsible for up to two-thirds of cases. Other viruses include rhinovirus, parainfluenza virus, adenovirus, influenza virus, human metapneumovirus, and SARS-CoV-2. These viruses infect the upper respiratory tract, then spread to the lower airways. Viral infection of the bronchioles causes inflammation, irritation, and increased mucus production, which narrows the airways and obstructs airflow. Common symptoms include a runny nose, cough, wheezing, and rapid or difficult breathing.
When Antibiotics Are Not Recommended
Antibiotics are designed to target and eliminate bacterial infections. Since bronchiolitis is caused by viruses, antibiotics have no effect on the underlying viral infection. Administering antibiotics in such cases does not shorten the duration of the illness, reduce symptoms, or prevent complications.
Unnecessary antibiotic use carries several risks, including potential side effects like diarrhea, rash, and allergic reactions. It can also disrupt the beneficial bacteria naturally present in the gut, which play a role in digestion and immune function. A significant concern is the contribution to antibiotic resistance, where bacteria evolve to become resistant to medications, making future bacterial infections harder to treat.
When Antibiotics Might Be Used
While antibiotics are not a standard treatment for bronchiolitis, there are specific situations where a healthcare professional might consider their use. This occurs when there is suspicion of a secondary bacterial infection developing alongside the viral bronchiolitis. Examples include bacterial pneumonia or an ear infection (otitis media).
Antibiotics may also be considered for certain high-risk infants who have underlying medical conditions, such as severe congenital heart disease, chronic lung disease, or immunodeficiency. These children may have a greater susceptibility to bacterial co-infections, and the decision to use antibiotics is based on a thorough clinical assessment, not as a routine measure for bronchiolitis itself. For instance, studies have shown that up to 40% of children with severe RSV bronchiolitis requiring intensive care may have bacterial co-infection in their lower airways.
Managing Bronchiolitis
The primary approach to managing bronchiolitis focuses on supportive care to alleviate symptoms and ensure the child’s comfort. Maintaining adequate hydration is important, which might involve offering small, frequent amounts of fluids orally or, in more severe cases, through a nasogastric tube or intravenous fluids. Fever can be managed with age-appropriate medications like acetaminophen or ibuprofen.
Nasal congestion, a common symptom, can be eased with saline nasal drops and gentle suctioning, particularly before feedings, to help clear the airways. Monitoring for signs of worsening respiratory distress is important, such as very rapid breathing (e.g., more than 60 breaths per minute in infants), grunting noises, flaring nostrils, or skin pulling in around the ribs or neck with each breath. If these signs appear, or if the child shows signs of dehydration or becomes unusually sleepy or unresponsive, immediate medical attention is necessary.
In more severe instances, hospitalization might be required for oxygen therapy to maintain blood oxygen saturation above 90% or for feeding support, but these interventions do not involve antibiotics as the main treatment.