A 6-week-old infant presents in winter with 3 days of rhinorrhoea, cough, respiratory rate 68/min, subcostal retractions, oxygen saturation 91% on room air, and diffuse bilateral expiratory wheeze and crepitations. Temperature is 37.6°C. RSV antigen test is positive. The MOST appropriate initial management is:

• A Nebulised salbutamol and oral prednisolone
• B IV ribavirin and respiratory syncytial virus immunoglobulin
• C Supplemental oxygen, nasopharyngeal suctioning, and supportive care; hydration via nasogastric tube if needed ✓
• D IV ampicillin and gentamicin for presumed bacterial superinfection

Explanation

RSV bronchiolitis management is primarily supportive — oxygen to maintain SpO2 >92%, nasal suctioning for mucous clearance, and ensuring adequate hydration (nasogastric tube feeding if respiratory distress prevents oral feeding). Multiple randomised controlled trials have demonstrated no benefit of bronchodilators (salbutamol, epinephrine), systemic steroids, antibiotics, or ribavirin in typical bronchiolitis. NICE guidelines and AAP guidelines recommend against routine use of bronchodilators or corticosteroids. Antivirals are reserved for severely immunocompromised patients.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.