It's winter again, and another respiratory season is on us
We're still not sure how best to treat RSV
Their arguments, of course, are fueled by published studies claiming that each of these modalities is beneficial and an equal number demonstrating that they are not. Although there is still no single and definitive therapy for bronchiolitis, we have learned a great deal about this condition in the past 50 years. Unfortunately, much of what we have learned has led to conclusions about what not to do rather than what we can and should do in managing this very common problem.
Polymerase chain reaction (PCR) tests now are available in many laboratories and permit detection of any of 10 or more viruses in a single respiratory specimen in a matter of hours. A recent study from the Netherlands, however, is just one of several such studies demonstrating that identification of a viral pathogen by real time-PCR does not lead to a reduction in hospitalization, shorter hospital stay, or reduced use of antibiotics, even when the results are available in 12 to 36 hours.1
Will today's pediatric residents practice in a time when bronchiolitis can be prevented as effectively as we now prevent measles, or will some future therapy effectively treat its symptoms? Perhaps. But for this winter, at least, we can teach them the things we've learned not to do.
1. Wishaupt JO, Russcher A, Smeets LC, Versteegh FG, Hartwig NG. Clinical impact of rt-PCR for pediatric acute respiratory infections: a controlled clinical trial. Pediatrics. 2011;128(5):e1113-e1120.
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