A 9-month-old infant presents in winter with 3 days of wheeze, tachypnea (RR 65/min), subcostal retractions, and SpO2 88% on room air. This is the first episode of wheeze. There is no family history of atopy. The most likely causative virus and the only specific antiviral therapy with any evidence is:

• A Influenza A; oseltamivir
• B Human metapneumovirus; ribavirin
• C Rhinovirus; no antiviral therapy
• D Respiratory syncytial virus (RSV); palivizumab (prophylaxis, not treatment) ✓

Explanation

Respiratory syncytial virus (RSV) causes >70% of bronchiolitis cases in infants <1 year, especially in winter months. Bronchiolitis management is primarily supportive (oxygen, hydration, suctioning). No specific antiviral treatment is effective or approved for acute RSV bronchiolitis. Palivizumab (anti-RSV monoclonal antibody) is used as prophylaxis in high-risk infants (prematurity <35 weeks, congenital heart disease, chronic lung disease) to prevent severe RSV disease — it is NOT a treatment. Nirsevimab, a newer longer-acting anti-RSV antibody, is now approved for prophylaxis. Ribavirin (inhaled) has insufficient evidence for routine use. Oseltamivir is for influenza.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.