OHP-008 Acute bronchiolitis: Therapeutic management suitability in a third level hospital

Abstract

BackgroundRespiratory syncytial virus (RSV) is a common infection among children, with nearly 70% of children affected by 2 years, 22% developing symptomatology and 2–5% requiring hospitalisation.National Clinical Practice guidelines and Paediatric Consensus Conference on acute bronchiolitis (AB) support the lack of effectiveness of most therapeutic interventions in AB caused by RSV.PurposeTo evaluate the suitability of therapeutic management in AB patients, in comparison with reference patterns, and to propose the establishment of corrective measures.Reference protocols make the following recommendations: contraindicate corticoids; not systematically indicate bronchodilator therapy and adrenaline; indicate palivizumab and ribavirine only in risk patients; indicate aerosolised 3% saline solution (SS); and supportive therapy (ST).Material and methodsRetrospective study including patients (≤2 years old) admitted to the paediatric unit from January to May 2015 with a diagnosis of AB.Variables were: diagnosis, RSV test, concomitant infection, antibiotherapy, risk factors (RF) (prematurity and complications), ST and palivizumab administration.Adequacy between established therapy and reference protocols was evaluated.Results250 patients ≤ 2 years old with AB were admitted to the paediatric unit during the above mentioned period. When admitted, 22 (9%) patients presented moderate to severe bronchiolitis and 60 (24%) presented RF (57% respiratory complications at birth, 27% prematurity and 17% other). Only one patient received palivizumab.RSV test results were: 205 (82%) positive, 40 (16%) negative.Only 13 (5%) patients presented concomitant infection when admitted, with 4 (80%) receiving antibiotics. The remaining 16 prescriptions were unjustified.Corticoids were prescribed in 97 (40%) patients, despite recommendations against its use in protocols.Bronchodilator therapy with salbutamol was prescribed in 144 (57%) patients, although data on its potential benefit in AB are conflicting and it is not systematically suggested.Adrenaline aerosols were conditionally prescribed in 16 (6%) patients, in concordance with not routinely recommended prescription.92 (36%) patients received aerosolised 3% SS alone or associated with a bronchodilator or adrenaline, recommended measure in protocols. ST was established in 100% of our patients, as recommended.ConclusionIn our population, the therapeutic approach in AB was far from the reference patterns, with usual establishment of non-effective measures. Elaboration and validation of a protocol between clinicians and pharmacists should be assssed as a corrective measure, in order to optimise AB management.No conflict of interest.