The term acute lower respiratory tract infection is used here to embrace acute viral bronchiolitis as well as acute viral and bacterial pneumonia. Antibiotics are indicated in the empiric treatment of pneumonia and are not usually indicated for the treatment of bronchiolitis. However, the decision to prescribe or omit antibiotics is influenced by several factors:
- The ability to clinically distinguish acute viral bronchiolitis from pneumonia.
- Laboratory and radiological findings cannot provide confident differentiation of viral bronchiolitis from bacterial pneumonia.
- The knowledge that a variable proportion of children diagnosed with bronchiolitis will have bacterial co-infection. This will be influenced by the local epidemiology of acute lower respiratory tract infections.
- The ability of the caregiver to monitor the child.
- The ease with which healthcare may be accessed in the event of clinical deterioration.
The sections below provide evidence-based recommendations for the treatment of bronchiolitis and pneumonia. Much of this evidence has been generated in developed countries.
If it is not possible to confidently diagnose acute viral bronchiolitis clinically or if there are concerns about bacterial co-infection it is recommended that the WHO treatment guidelines should be followed and that antibiotics should be given to young children with an acute onset of cough associated with wheeze, tachypnoea and chest indrawing as described in the section on pneumonia.
Nebulize all wheezing children with a β₂ agonist and if a good clinical response is noted and wheezing is recurrent, consider asthma.