Bronchiolitis Drug Summary

Drug	Dosage	Remarks
Ribavirin	20 mg/mL via inhalation delivered over 12-18 hourly for at least 3 days Max duration: 7 days  Use a small particle aerosol generator (SPAG) to administer the drug Carefully selected hospitalized infants and young children: 100 mg PO 6 hourly x 5 days	Adverse Reactions CNS effects (fatigue, headache, insomnia); GI effects (nausea, anorexia); Hematologic effect (anemia) Less commonly: CV effects (hypotension, cardiac arrest); Respiratory effects (mild bronchospasm, apnea, worsening of respiratory function); Dermatologic effects (skin irritation, rash); Ocular effect (conjunctivitis) May be mutagenic, tumor-promoting, and gonadotoxic Special Instructions Contraindicated in patients with severe heart disease, hemoglobinopathies, severe hepatic dysfunction, autoimmune disease Use with caution in patients with hepatic or renal impairment and anemia Monitor for anemia 1-2 weeks post-treatment Drug may precipitate in respiratory equipment, thus interfering with effective patient ventilation Patients must be monitored for deterioration of respiratory function Precautions should be taken to decrease atmospheric pollution with aerosol Ribavirin administration Remove liquids in SPAG every 24 hours and when the liquid level is low before adding a new solution Should not be mixed with other medication

Drug	Dosage	Remarks
Acetylcysteine	1-2 years old: 100 mg PO 24 hourly 2-6 years old: 200-400 mg PO 24 hourly x 5-10 days	Adverse Reactions Occasionally, slight GI effects (nausea, dyspepsia, pyrosis, stomatitis); Respiratory effect (rhinitis) Special Instructions Dissolve the granules in about ½ glass of water, avoiding the addition of drugs to the liquid
Ambroxol	2-5 years old: 7.5-15 mg PO 8 hourly 6-12 years old: 15-30 mg PO 8-12 hourly ≥12 years old: 60-120 mg PO 8-12 hourly	Adverse Reactions GI effect (nausea/vomiting, diarrhea); Other effects (headache, polyuria, fatigue) Special Instructions Should not be taken in an empty stomach Use with caution in patients with gastric ulcer
Cyclidrol	>2 years old: 80 mg PO 12 hourly	Adverse Reactions GI effects (abdominal pain); Dermatologic effect (cutaneous rash) Special Instructions Use with caution in patients with renal impairment
Dextromethorphan	6-<12 years old: 15 mg PO 6-8 hourly ≥12 years old: 10-20 mg PO 4-6 hourly	Adverse Reactions CNS effects (dizziness, rarely excitation and confusion); GI disturbances Special Instructions Use with caution in infants and patients with respiratory failure, asthma and taking MAO inhibitors
Dried ivy leaf extract	Syr: 1-5 years old: 2.5 mL PO 8 hourly 6-10 years old: 5 mL PO 8 hourly Effervescent tab: 6-12 years old: 32.5 mg PO 12 hourly	Adverse Reactions Rarely, laxative effect due to sorbitol content Special Instructions Use with caution in patients with fructose/sorbitol intolerance
Erdosteine	15-<20 kg: 175 mg PO 12 hourly 20-30 kg: 175 mg PO 8 hourly >30 kg: 300 mg PO 12 hourly	Adverse Reactions CNS effect (headache); GI disturbances (nausea/vomiting, loose stools) Special Instructions Avoid use in patients with active peptic ulcer

Drug	Dosage	Remarks
Nirsevimab	Neonates and infants  <5 kg: 50 mg IM as a single dose Neonates and infants  ≥5 kg: 100 mg IM as a single dose	Adverse Reactions Local effects (injection site erythema, induration); Hypersensitivity reactions (rash, urticaria, cyanosis, hypotonia) Special Instructions Use with caution in patients with thrombocytopenia or any coagulation disorder Administer preferably into the anterolateral aspect of the thigh
Palivizumab	15 mg/kg IM once monthly during RSV season Max dose: 3 doses for patients without significant heart/lung disease born 32-34 6/7 weeks; 5 doses for others	Adverse Reactions Local effects (injection site erythema, induration); GI effects (vomiting, diarrhea, gastroenteritis); Hepatic effect (increased AST levels); Respiratory effects (upper respiratory tract infection, wheezing); CNS effects (fever, nervousness); Dermatologic effect (rash) Special Instructions Use with caution in patients with thrombocytopenia or any coagulation disorder Administer preferably into the anterolateral aspect of the thigh
RSV-Ig	Adolescents:  0.5 mL IM as a single dose	Adverse Reactions CV effects (tachycardia, hypertension, hypotension); CNS effect (headache); Dermatologic effect (rash); GI effects (vomiting, diarrhea, gastroenteritis); Injection site inflammation, fever Special Instructions Contraindicated in patients with hemodynamically significant heart disease Use with caution in patients with underlying pulmonary disease who may be sensitive to fluid overload Use with caution in patients at high risk of developing renal failure Defer vaccination against MMR and varicella 9 months after last dose Booster doses of oral polio, DPT and HIB may be considered 3-4 months after the last dose of RSV-IVIg to ensure immunity

All dosage recommendations are for children with normal renal and hepatic function unless otherwise stated. 
Not all products are available or approved for above use in all countries. 
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs. 
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.