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Parainfluenza Virus Medication

  • Author: Subhash Chandra Parija, MBBS, MD, PhD, FRCPath, DSc; Chief Editor: Mark R Wallace, MD, FACP, FIDSA  more...
Updated: Oct 07, 2015

Medication Summary

No specific antiviral agents have been established as beneficial for treating human parainfluenza virus (HPIV) infections; however, ribavirin is sometimes given. Medications are administered to treat the respiratory symptoms associated with croup (eg, airway inflammation and edema). Such medications include corticosteroids and nebulized epinephrine. Antibiotics are used only if bacterial complications (eg, otitis and sinusitis) develop.



Class Summary

Corticosteroids have anti-inflammatory properties and cause profound and varied metabolic effects. They modify the body’s immune response to diverse stimuli. Anti-inflammatory drugs (specifically, dexamethasone) help reduce the inflammation and subglottic edema of croup. Despite its delayed onset of action, the high potency and prolonged intramuscular half-life of dexamethasone make it the preferred corticosteroid for croup.

Dexamethasone (Baycadron)


Dexamethasone decreases airway inflammation by inhibiting migration of phagocytes and reversing capillary permeability, thereby reducing the edema that occurs in croup. It is the preferred anti-inflammatory drug for reducing airway edema in this setting, though other glucocorticoids have been used, including prednisone and prednisolone.

Budesonide inhaled (Pulmicort Respules, Pulmicort Flexhaler)


When nebulized, budesonide is useful for reducing inflammation and edema in patients with croup. It alters the level of inflammation in airways by inhibiting multiple types of inflammatory cells and decreasing production of cytokines and other mediators. Turbuhaler is used for adults; Pulmicort Respules is used only for children aged 1-8 years.



Prednisone may decrease inflammation by reversing increased capillary permeability and suppressing the activity of polymorphonuclear leukocytes (PMNs).

Prednisolone (Orapred, Pediapred, Millipred)


Prednisolone decreases inflammation by suppressing migration of PMNs and reducing capillary permeability. Many practitioners administer liquid prednisolone to patients with croup in lieu of dexamethasone. Prednisolone has not been proved superior to dexamethasone.

Methylprednisolone (Medrol, Solu-Medrol, A-Methapred)


Methylprednisolone blocks release of inflammatory mediators by inhibiting phospholipase A2. It may be useful in patients who have either asthma or bronchiolitis with asthmatic qualities.


Alpha/Beta Agonists

Class Summary

When delivered by air or oxygen-powered devices, epinephrine is directly delivered to respiratory mucosal surfaces and smooth muscle. Because nebulizers deliver the medication directly to the target organ, fewer systemic adverse effects are encountered than are seen with oral or parenteral administration.

Epinephrine racemic (Adrenalin, Twinject, EpiPen 2-Pak)


Racemic epinephrine solution causes alpha-adrenergic receptor–mediated vasoconstriction of edematous tissues, thereby reversing upper airway edema. It provides short-term relief. In concentrations of 1:1000, L-epinephrine may be used in place of racemic epinephrine for nebulized administration.


Antiviral, Other

Class Summary

Ribavirin is licensed by the US Food and Drug Administration (FDA) for the management of RSV bronchiolitis and pneumonia. It has a broad spectrum of antiviral activity in vitro, inhibiting replication of RSV as well as influenza, parainfluenza, adenovirus, measles, Lassa fever, and Hantaan viruses. No antiviral agents have been established as beneficial for treating human parainfluenza virus (HPIV) infections; however, ribavirin is sometimes given.

Ribavirin (Virazole)


Ribavirin (1-beta-D-ribofuranosyl-1,2,4-triazole-3-carboxamide) is a synthetic nucleoside analogue that resembles guanosine and inosine. It is believed to act by interfering with expression of messenger RNA and inhibiting viral protein synthesis. Ribavirin appears safe but is expensive. Its efficiency and effectiveness have not been clearly demonstrated in large, randomized, placebo-controlled trials. At present, routine use of ribavirin cannot be recommended.

Contributor Information and Disclosures

Subhash Chandra Parija, MBBS, MD, PhD, FRCPath, DSc Director-Professor of Microbiology, Head of Department of Microbiology, Jawaharlal Institute, Postgraduate Medical Education and Research, India

Subhash Chandra Parija, MBBS, MD, PhD, FRCPath, DSc is a member of the following medical societies: Royal College of Pathologists, Indian Society for Parasitology, Indian Medical Association, National Academy of Medical Sciences (India), Indian Association of Medical Microbiologists, Indian Association of Biomedical Scientists, Indian Association of Pathologists and Microbiologists, Indian Academy of Tropical Parasitology

Disclosure: Received salary from Jawaharlal Institute of Postgraduate Medical education & Research , Pondicherry , India for employment.


Thomas J Marrie, MD Dean of Faculty of Medicine, Dalhousie University Faculty of Medicine, Canada

Thomas J Marrie, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society for Microbiology, Association of Medical Microbiology and Infectious Disease Canada, Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Chief Editor

Mark R Wallace, MD, FACP, FIDSA Clinical Professor of Medicine, Florida State University College of Medicine; Clinical Professor of Medicine, University of Central Florida College of Medicine

Mark R Wallace, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, International AIDS Society, Florida Infectious Diseases Society

Disclosure: Nothing to disclose.


Jeffrey D Band, MD Professor of Medicine, Oakland University William Beaumont School of Medicine; Director, Division of Infectious Diseases and International Medicine, Corporate Epidemiologist, William Beaumont Hospital; Clinical Professor of Medicine, Wayne State University School of Medicine

Disclosure: Nothing to disclose.

Richard B Brown, MD, FACP Chief, Division of Infectious Diseases, Baystate Medical Center; Professor, Department of Internal Medicine, Tufts University School of Medicine

Richard B Brown, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Chest Physicians, American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, and Massachusetts Medical Society

Disclosure: Nothing to disclose.

Joseph Domachowske, MD Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University

Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Ashir Kumar, MD, MBBS, FAAP Professor Emeritus, Department of Pediatrics and Human Development, Michigan State University College of Human Medicine

Ashir Kumar, MD, MBBS, FAAP is a member of the following medical societies: American Association of Physicians of Indian Origin and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Russell W Steele, MD Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Roy M Vega, MD Assistant Professor of Pediatrics, Albert Einstein College of Medicine; Director, Pediatric Emergency Services, Department of Emergency Medicine, Bronx Lebanon Hospital Center, Bronx, NY

Roy M Vega, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

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Transmission electron micrograph of parainfluenza virus. Two intact particles and free filamentous nucleocapsid.
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