Management of Wheezing

Main causes of wheezing are

• Bronchiolitis
• Asthma
• Inhaled foreign body
• Lymph nodes compressing bronchus
• Along with respiratory infections.

Clinical Signs

Audible wheeze

• Prolonged expiratory phase of respiration
• Effort in breathing out.

Treatment

Use nebulized salbutamol (5 mg/ml) (0.5 ml of salbutamol + 2 ml of normal saline) with oxygen. This can be repeated every 20 minutes (maximum 3 doses) if the response to initial dose is not satisfactory.

• If there is no response to initial 3 doses of nebulized salbutamol, it is better to admit the child and start IV Aminophylline 5 mg/kg/dose—as infusion in 20 minutes.
• Along with aminophylline, hydrocortisone 10 mg/kg/dose IV followed by 5 mg/kg/day every 6 hours is given. Once the patient starts to accept oral feeds, Tab.Prednisolone 1 mg/kg per day in 3-4 div. doses is given for 5 days.
• If nebulized salbutamol is not available, subcutaneous adrenaline (0.01 ml/kg) or subcutaneous terbutaline (0.01 ml/kg) may be given

Acute Otitis Media

• Pneumococcus: 40%
• H. influenzae: Non-typable—25-30%
• Moraxella catarrhalis: 10-15%.

Treatment

Oral Amoxycillin × 10 days as second line drugs, three drugs are used:

1. Amoxycillin + Clavulanate 2. Cefuroxime Axetil 3. IM—Ceftriaxone.

Acute Sinusitis

• Viral
• Bacterial: — Pneumococcus — Non-typable H.influenzae — Moraxella catarrhalis Acute bacterial sinusitis usually follows a viral upper respiratory tract infection. They present with nasal congestion, nasal discharge (unilateral/bilateral) and cough. Persistent symptoms of upper respiratory tract infection, including nasal discharge and cough lasting for more than 10-14 days without improvement and severe respiratory symptoms, are suggestive of complicating acute bacterial sinusitis.

Treatment

Oral Amoxycillin: 45 mg/kg/day in 3 divided. doses × 10 days

• Use of decongestants, antihistamines, mucolytics are not recommended for management of sinusitis.