New Bronchiolitis Guidelines
The American Academy of Pediatrics (AAP) has instituted new diagnostic and therapeutic guidelines for bronchiolitis, a viral disease of the lower respiratory tract. Even with the new guidelines, there is still a large variance in treatment practices. Diagnosis should be made through clinical investigation, not through the use of laboratory or radiologic tests. Risk stratification should include assessment of risk factors for severed disease (e.g., prematurity, underlying lung or heart disease, and immunodeficiency). Hydration and oxygen saturation need to be assessed and corrected as appropriate. Bronchodilators should not be used routinely, but they can be used on an optional trial basis, if indicated by objective measures. Antibiotics should not be used either, unless a clear bacterial infection is postulated. Steroids and ribavirin are not recommended. In the high-risk groups, prophylactic palivizumab is recommended and should be administered in five monthly doses during the respiratory syncytial virus season. Finally, all caregivers should remember to wash their hands and protect the child from any exposure to secondhand smoke.
Letter to the Editor – Acute Otitis Media
From my rotations, I have received opposing opinions on how to treat acute otitis media. Some tell me I should treat it with amoxicillin, 40 to 45 mg/kg/day, but then some say I need to use a higher dose, such as 80 to 90 mg/kg/day. Which should I give?
There are still many variations in dosing when dealing with acute otitis media (AOM). This is because the dosing in the past used to be recommended at the lower dose you describe in your letter. Newer recommendations from the American Academy of Pediatrics state that high-dose amoxicillin should be used, up to the adult dose of 875 mg twice daily. When using amoxicillin with clavulanic acid, you still use the higher dose, and base it on the amoxicillin dose. In addition, some have even advocated not treating initially, since about half of the infections have a viral origin. This alternative involves giving the parent a prescription for antibiotics, with instructions to begin treatment only if the child is not better in 48 hours. This method has the potential to reduce costs, side-effects, and resistance patterns in treating AOM.