Treatment of Acute Bronchiolitis in a Resource-limited Setting in Port Sudan City: A simple Effective Regimen

Abstract

Background: Bronchiolitis is an acute lower respiratory viral infection, caused by the Respiratory Syncytial Virus (RSV) in 60–85% of cases and other respiratory viruses in remaining ones. It is the leading cause of hospitalization for infants and toddlers during the winter and early spring months. At the moment, there is no consensus on its treatment worldwide. The prevalence is increasing in port Sudan eastern Sudan, while we have no admission policy or a unified management protocol. Therefore, the aim of this study is: (1) to formulate an admission policy and a new simple management protocol; (2) to determine the factor(s) that increased the prevalence in port Sudan as a secondary objective; and (3) to compare the outcome in the study (119 infants) and historical (135 infants) groups concerning the hospitalization length and death rate as a primary objectives. Method: This is a hospital-based, controlled clinical trial (CCT) study, demographic data were collected by a questionnaire, and data were analyzed manually. Severity criteria for acute bronchiolitis are defined. A management guideline was defined and applied to bronchiolitis cases (119 case) with intention to treat, from October to April each year (2013–2015). All infants aged between 1 and 23 months with only acute bronchiolitis were included, while cases with bronchiolitis and associated dysmorphic features, heart disease, tracheo-oesophageal fistula, other respiratory diseases, other morbidities, infants below one month or above two years were excluded from this study. The outcome was compared to a group of matched infants with bronchiolitis (135 cases) who received antibiotics, B2 agonist, and steroids, between October and April of years 2011–2012. Results: While several new lifestyle factors increased the prevalence, the new guidelines decreased the admission rate (9.6 vs 5.7 mo), is simple and effective, less expensive, and the duration of hospitalization also reduced (p = 0.04). Key words:  acute bronchiolitis, resource-limited settings, advanced respiratory intervention, simple effective intervention,S-7Pro3NO regimen