A 6-week-old infant has a 5-day history of worsening cough and wheeze, low-grade fever (37.8°C), and oxygen saturation of 91% on room air. CXR shows hyperinflation with bilateral patchy infiltrates. The most likely causative virus and whether antibiotics are indicated is:
- A Rhinovirus — antibiotics not indicated
- B Parainfluenza virus — amoxicillin for secondary bacterial pneumonia
- C Respiratory syncytial virus (RSV) — accounts for 50–80% of bronchiolitis cases; antibiotics not routinely indicated ✓
- D Adenovirus — requires IV ribavirin treatment
Correct answer: C. Respiratory syncytial virus (RSV) — accounts for 50–80% of bronchiolitis cases; antibiotics not routinely indicated
Explanation
RSV is the most common cause of acute viral bronchiolitis in infants under 2 years of age, peaking in winter months. Management is supportive — oxygen, nasogastric feeding, and fluids. Antibiotics are not routinely indicated as primary bacterial superinfection is uncommon. Neither bronchodilators (salbutamol) nor corticosteroids are recommended in routine bronchiolitis management per AAP/NICE guidelines. Palivizumab prophylaxis is given to high-risk infants (preterm, CHD, chronic lung disease) before RSV season.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.