# Acute Bronchiolitis - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: MSF Essential Drugs 2024 - paracetamol (oral) · No dose - supportive care, no medicine given · Erickson EN, Bhakta RT, Tristram D, Mendez MD. Pediatric Bronchiolitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Last Update: January 12, 2025. · AAP Clinical Practice Guideline: Bronchiolitis 2014 · NICE Guideline NG9: Bronchiolitis in children 2021 - Verified date: 2026-08 ## Verified against - MSF Essential Drugs 2024 - paracetamol (oral) - No dose - supportive care, no medicine given - Pediatric Bronchiolitis - disease-level clinical article (bronchiolitis-infantile-clinical.txt) ## Treatment metadata - No drug therapy in primary care (Supportive care) - Referral & safety-netting (no drug therapy) - Paracetamol — 500 mg — oral.solid ## Complete treatment card ```text ACUTE BRONCHIOLITIS Sources: MSF Essential Drugs 2024 - paracetamol (oral) · No dose - supportive care, no medicine given · Erickson EN, Bhakta RT, Tristram D, Mendez MD. Pediatric Bronchiolitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Last Update: January 12, 2025. · AAP Clinical Practice Guideline: Bronchiolitis 2014 · NICE Guideline NG9: Bronchiolitis in children 2021 Review status: REVIEWED against MSF Essential Drugs 2024 - paracetamol (oral), No dose - supportive care, no medicine given, Pediatric Bronchiolitis - disease-level clinical article (bronchiolitis-infantile-clinical.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (2) - Cough, congestion, and runny nose come first, with or without fever, as the virus initially affects the upper airway [cough · runny nose] - Parents notice fast or labored breathing, trouble feeding, or blue discoloration of the lips and nailbeds after a cold-like start [breathlessness · cyanosis] SIGNS - what you find (5) - Low fever with a fast respiratory rate and low oxygen saturation are common on exam [fever · hypoxia] - Breathing faster than 100 times a minute is typical and often makes feeding difficult - Grunting, flared nostrils, retractions between the ribs, and belly breathing are key exam findings [chest recession] - Widespread wheezing heard on both breathing in and out across the lungs is the classic auscultation finding [wheeze] - A tired, pale infant with poor air movement warns of impending respiratory failure needing urgent airway support [fatigue · pallor] TESTS (4) - Oxygen saturation helps decide on hospital admission and the need for supplemental oxygen - Fast breathing over 60 breaths per minute or saturation below 92% should prompt considering admission and oxygen - Rapid viral testing on a nasal sample can identify the causative virus and guide isolation and room placement - Chest x-ray is not usually recommended, since findings like hyperinflation and interstitial markings are nonspecific IF NOT THIS - what else fits (2) - Reflux disease, aspiration pneumonia, and an inhaled foreign body in the lower airway are alternatives to consider - Congenital vascular rings or slings, an asthma flare, or anaphylaxis can present similarly Source StatPearls "Pediatric Bronchiolitis" - disease-level clinical article Status traced to the source above 1. NO DRUG THERAPY IN PRIMARY CARE (SUPPORTIVE CARE) [1st line] Adult Bronchiolitis is a disease of infants, usually under 12 months. There is no effective drug treatment: management is small frequent feeds, nasal saline and suction if feeding is blocked, and watching the work of breathing. - Supportive, through the illness Peds This IS the paediatric entry - the condition does not occur in adults. Admit if feeding drops below about half of normal, or if there is apnoea, grunting, marked recession or cyanosis. Source No dose - supportive care, no medicine given Why Supportive care is the mainstay - hydration, feeding, nasal suctioning, and oxygen for hypoxaemia - alongside recognising the infant who is tiring. Steroids are not recommended, and antibiotics are reserved for clear evidence of a superimposed infection. Bronchodilators are not universally effective, though a trial of aerosolised salbutamol may be considered for an infant with severe respiratory compromise. Caution A DISEASE OF INFANTS - it does not occur in adults, so no adult regimen applies. Inhaled or oral steroids do not alter the course, and antibiotics are only for clear evidence of a superimposed infection. Bronchodilators are not universally effective, but a trial of aerosolised salbutamol may be considered, especially for an infant with severe respiratory compromise. Admit if feeding falls below roughly half of normal intake. RED FLAG - Apnoea episodes, marked respiratory distress with grunting, severe recession or nasal flaring, or poor feeding or dehydration. 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Pediatric Bronchiolitis - disease-level clinical article (bronchiolitis-infantile- clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - The criteria for hospitalization and supplemental oxygen are tachypnea >60 breaths/min, SpO2 <92%, or inability to feed. 3. PARACETAMOL [add-on - not a substitute] Adult For fever or discomfort in the infant, dosed by weight - see the paediatric calculation. Bronchiolitis does not occur in adults, so the adult column does not apply here. - As needed for pain or fever Peds 15 mg/kg/dose [child max 500 mg] (Child 1 month and over: 15 mg/kg per dose, 3 or 4 times daily, maximum 60 mg/kg daily. Child under 1 month: 10 mg/kg per dose, 3 or 4 times daily, maximum 40 mg/kg daily. MSF's own weight table gives one 500 mg tablet three times daily from 30 kg to under 50 kg, so 500 mg is the per-dose ceiling; the 60 mg/kg daily total still applies.) 3kg -> 45 mg/dose 4kg -> 60 mg/dose 5kg -> 75 mg/dose 6kg -> 90 mg/dose 7kg -> 105 mg/dose 8kg -> 120 mg/dose 9kg -> 135 mg/dose 10kg -> 150 mg/dose 11kg -> 165 mg/dose 12kg -> 180 mg/dose 13kg -> 195 mg/dose 14kg -> 210 mg/dose 15kg -> 225 mg/dose 16kg -> 240 mg/dose 17kg -> 255 mg/dose 18kg -> 270 mg/dose 19kg -> 285 mg/dose 20kg -> 300 mg/dose 21kg -> 315 mg/dose 22kg -> 330 mg/dose 23kg -> 345 mg/dose 24kg -> 360 mg/dose 25kg -> 375 mg/dose 26kg -> 390 mg/dose 27kg -> 405 mg/dose 28kg -> 420 mg/dose 29kg -> 435 mg/dose 30kg -> 450 mg/dose 31kg -> 465 mg/dose 32kg -> 480 mg/dose 33kg -> 495 mg/dose 34kg -> 500 mg/dose (capped) 35kg -> 500 mg/dose (capped) 36kg -> 500 mg/dose (capped) 37kg -> 500 mg/dose (capped) 38kg -> 500 mg/dose (capped) 39kg -> 500 mg/dose (capped) 40kg -> 500 mg/dose (capped) 41kg -> 500 mg/dose (capped) 42kg -> 500 mg/dose (capped) 43kg -> 500 mg/dose (capped) 44kg -> 500 mg/dose (capped) 45kg -> 500 mg/dose (capped) 46kg -> 500 mg/dose (capped) 47kg -> 500 mg/dose (capped) 48kg -> 500 mg/dose (capped) 49kg -> 500 mg/dose (capped) 50kg -> 500 mg/dose (capped) Source MSF Essential Drugs 2024 - paracetamol (oral) Why Symptomatic relief of the pain and fever only. It does not treat the cause, and the dose is the same whatever the cause is. Caution Dose the INFANT by weight - the adult figure carried on other screens is not the dose here. Relief only - it does not treat what is causing the pain or fever. Check every other product the patient is taking for paracetamol; combination cold and flu preparations are the usual route to an accidental overdose. Reduce the dose in significant liver disease, chronic alcohol use, or low body weight. RED FLAG - Admit or refer the infant for apnoea episodes, marked respiratory distress with grunting, severe chest retraction or nasal flaring, poor feeding or dehydration, or low oxygen saturation or a bluish colour. A very young infant, or one with underlying heart or lung disease or prematurity, warrants a lower threshold for admission. Egypt FEBRIMOL 500 MG 20 TAB. PHARCO 3.50 EGP (0.17/unit) CETAMOL 500 MG 20 TABS. MEMPHIS 8.00 EGP (0.40/unit) PARACETAMOL-MUP 500MG B.P. 20 TABS. MUP 13.00 EGP (0.65/unit) CETAL 500 MG 20 TABS. EIPICO 24.00 EGP (1.20/unit) ARKADOLOW 500 MG 30 F.C. TABS. UTOPIA 42.00 EGP (1.40/unit) PARAMOL 500MG 20 TAB. MISR 38.00 EGP (1.90/unit) ADOL 500MG 24 CAPLETS JULPHAR 32.00 EGP AUGICETAMIDE 500 MG 20 SACHETS AUG PHARMA 50.00 EGP FEBRIMOL ORAL DROPS 20 ML PHARCO 4.00 EGP -> ? strength differs, ? different route - not oral solid THERA-LO 3.2G/100ML ORAL SUSP. 100 ML PHAROPHARMA 5.00 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)