Management of RSV Bronchiolitis in Outpatient Setting

Abstract

Seasonal respiratory syncytial virus (RSV) lower respiratory infections (RSV-LRI) and bronchiolitis in children remain a high burden to medical facilities. Studies evaluating the practical approach in outpatient settings are scarce. We conducted a survey to provide an insight into management in pediatric offices in Germany. Invitations for participation in an online survey were sent to 623 providers of pediatric primary care via email. Recipients were randomly chosen from national databanks based on zip codes. The response rate was 16,2%, n=92 (14,7%) questionnaires were fully answered and analyzed. 93,5% (n=86) are board certified pediatricians. In outpatient setting, every second patient with suspected or confirmed RSV-LRI is presented three times or more. 40,7% of our participants refer less than 10% of all patients to hospital, 83,7% refer less than one third (<30%). 33,7% of all participants never perform virological testing in suspected cases of RSV-LRI. More than 50% of all participants prescribe bronchodilators, hypertonic saline inhalation is prescribed by 17,4%. Antibiotics are prescribed in less than 10% of all cases of RSV-LRI. About 3/4 ask for a clearer, more conclusive guideline regarding prophylaxis. The diagnostic approach varies significantly. Although not recommended in international guidelines, bronchodilators are still frequently used. Considering emerging options for passive immunization, broader inclusion criteria into immunization regimes are requested by the participants. More conclusive guidelines and recommendations could further improve the management of outpatient RSV-LRI in children.

Zusammenfassung

Saisonale Infektionen mit dem Respiratorischen Synzytialvirus (RSV) bei Kindern sind eine große Belastung für medizinische Einrichtungen. Während die stationäre Versorgung gut untersucht ist, gibt es zum Vorgehen im ambulanten Bereich bisher nur wenig Erkenntnisse. Unsere Umfrage ermöglicht einen Einblick in das praktische Management von RSV Infektionen und der Bronchiolitis in pädiatrischen Praxen in Deutschland. Einladungen zur Teilnahme wurden deutschlandweit per E-Mail an 623 kinderärztliche Praxen geschickt. Die Empfänger wurden nach dem Zufallsprinzip aus nationalen Postleitzahlen-Datenbanken ausgewählt. Die Rücklaufquote betrug 16,2 Prozent, n=92 (14,7%) Fragebögen wurden vollständig beantwortet und gingen in die Auswertung ein. 93,5% (n=86) der Teilnehmer sind Fachärzte für Kinder- und Jugendmedizin. Im ambulanten Bereich wird jeder zweite Patient mit RSV-Infektion drei Mal oder häufiger vorgestellt. 40,7% der Befragten weisen weniger als 10% aller Patienten, 83,7% weniger als ein Drittel (<30%) in die Klinik ein. 33,7% aller Teilnehmer führen bei Verdacht auf RSV-Infektion nie einen virologischen Test durch. Mehr als 50% aller Teilnehmer verschreiben Bronchodilatatoren, 17,4% hypertone Kochsalzinhalation. Antibiotika werden in weniger als 10% der Fälle verschrieben. Etwa 3/4 fordern eine klarere, schlüssigere Leitlinie zur Prophylaxe. Der diagnostische Ansatz variiert. Inhalative Bronchodilatatoren werden häufig eingesetzt, auch wenn sie in internationalen Leitlinien nicht empfohlen werden. Angesichts neuer Möglichkeiten der passiven Immunisierung wird von den Befragten mehrheitlich eine breitere Indikationsstellung hierzu gefordert. Das ambulante Management von RSV-Infektionen könnte durch konkretere Empfehlungen verbessert werden.

Keywords

outpatient - burden - bronchiolitis - infant - children - RSV

Schlüsselwörter

ambulant - Praxis - Belastung - Säugling - Kleinkind - Gesundheitswesen

Publication History

Article published online:
20 September 2024

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