eMedicine Specialties > Infectious Diseases > Viral Infections
Parainfluenza Virus: Treatment & Medication
Updated: Jul 24, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Treatment
Medical Care
- Supportive care is mandatory. Antiviral agents are of uncertain benefit. Anecdotal reports of possible benefit have been published, but controlled studies are lacking.
- Treatment of croup
- Prehospital care
- It is paramount to control fever and to relieve respiratory symptoms.
- Respiratory symptoms are improved by exposing children to cool night air or by inhalation of vapor droplets to soothe inflamed airways.
- Antipyretics may be administered to control fever.
- Moderate or severe croup requires medical evaluation in the office or ED.
- ED care
- Mild croup: Cool oxygen mist and control of fever are effective in the treatment of mild croup.
- Moderate croup: Therapy includes cool oxygen mist and, possibly, orally administered glucocorticoids. If patients fail to improve, racemic epinephrine nebulization has been shown to be beneficial. Hydration must be maintained with oral fluids or with intravenous fluids, when necessary.
- Severe croup: In cases of impending respiratory failure, intensive-care monitoring is required in addition to repeat racemic epinephrine nebulization at 1- to 2-hour intervals. Endotracheal intubation followed by a tracheotomy may be required in patients with severe respiratory obstruction.
- Prehospital care
Consultations
Consultations may include pulmonologists and infectious diseases specialists.
Medication
Ribavirin is a broad-spectrum antiviral agent that has been shown to be effective against HPIV-3 infection in vitro and possibly in vivo. Although results are mixed, ribavirin aerosol or systemic therapy has been used to treat HPIV infections in children and adults who are severely immunocompromised. Use at this time is of uncertain clinical benefit.
Antibiotics are used only if bacterial complications (eg, otitis, sinusitis) develop. Corticosteroids and nebulizers are used to treat respiratory symptoms and to help reduce the inflammation and airway edema of croup.
Corticosteroids
Prednisone, prednisolone, and dexamethasone are commonly used glucocorticoids. Dexamethasone, because of its high potency and prolonged intramuscular half-life, is the preferred anti-inflammatory drug for croup.
Dexamethasone (Decadron, Solurex, Dexasone)
Decreases airway inflammation by inhibiting migration of phagocytes and reversing capillary permeability, thereby reducing edema occurring in croup.
Adult
10 mg/d PO/IV/IM
Pediatric
0.6 mg/kg/d PO/IM
Effects decrease with coadministration of barbiturates, phenytoin, and rifampin; decreases effect of salicylates and vaccines used for immunization
Documented hypersensitivity; active untreated bacterial or fungal infection
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in patients with tuberculosis or ocular herpes simplex infection; increases risk of multiple complications, including severe infections; monitor adrenal insufficiency when tapering drug; abrupt discontinuation may cause adrenal crisis; hyperglycemia, edema, osteonecrosis, myopathy, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, myasthenia gravis, growth suppression, and infections are possible complications
Budesonide (Pulmicort Respules, Turbuhaler)
Nebulized, this agent is useful to reduce inflammation and edema in patients with croup. Alters 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 y.
Adult
Not to exceed 1.6 mg/d nebulized
Pediatric
<6 years: Not established for Pulmicort Turbuhaler
>6 years: Not to exceed 400 mcg bid of Pulmicort Turbuhaler
1-8 years: Not to exceed 1 mg/d of Pulmicort Respules; not for use in children > 8 y
None reported
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Not used to abort acute asthmatic episodes
Prednisone (Deltasone, Orasone, Meticorten, Sterapred)
May decrease inflammation by reversing increased capillary permeability and suppressing PMN activity.
Adult
5-60 mg/kg/d PO; taper as symptoms resolve
Pediatric
0.14-2 mg/kg/d PO; taper as symptoms resolve
Coadministration with estrogens may decrease prednisone clearance; concurrent use with digoxin may cause digitalis toxicity secondary to hypokalemia; phenobarbital, phenytoin, and rifampin may increase metabolism of glucocorticoids (consider increasing maintenance dose); monitor for hypokalemia with coadministration of diuretics
Documented hypersensitivity; viral infection, peptic ulcer disease, hepatic dysfunction, connective-tissue infections, and untreated fungal or tubercular skin infections; GI disease
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Abrupt discontinuation of glucocorticoids may cause adrenal crisis; hyperglycemia, edema, osteonecrosis, myopathy, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, myasthenia gravis, growth suppression, and infections may occur with glucocorticoid use
Prednisolone (Delta-Cortef, Articulose-50, Econopred)
Decreases inflammation by suppressing migration of PMN leukocytes and reducing capillary permeability.
Adult
5-60 mg/kg/d PO; taper as symptoms resolve
Pediatric
0.14-2 mg/kg/d PO; taper as symptoms resolve
Decreases effects of salicylates and toxoids (for immunizations); phenytoin, carbamazepine, barbiturates, and rifampin decrease effects of corticosteroids
Documented hypersensitivity; viral, untreated fungal, or tubercular skin lesions
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in patients with hyperthyroidism, osteoporosis, cirrhosis, nonspecific ulcerative colitis, peptic ulcer, diabetes, and myasthenia gravis
Sympathomimetics
Epinephrine is highly effective when delivered via nebulizer. Nebulizers are air- or oxygen-powered devices that deliver medications directly to mucosal surfaces of respiratory tract and smooth muscles.
Epinephrine (AsthmaNefrin, microNefrin, S-2)
Racemic epinephrine solution causes alpha-adrenergic receptor–mediated vasoconstriction of edematous tissues, thereby reversing upper airway edema. Provides short-term relief.
Adult
3 mL isotonic NaCl solution mixed with 0.5 mL epinephrine solution and nebulized q1-2h prn
Pediatric
Administer as in adults
Increases toxicity of beta- and alpha-blocking agents and that of halogenated inhalational anesthetics
Documented hypersensitivity; cardiac arrhythmias; angle-closure glaucoma; during labor (may delay second stage of labor)
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in elderly persons, individuals with prostatic hypertrophy, hypertension, cardiovascular disease, tachycardia (especially with HR >200 bpm), diabetes mellitus, hyperthyroidism, and cerebrovascular insufficiency; rapid IV infusions may cause death from cerebrovascular hemorrhage or cardiac arrhythmias
More on Parainfluenza Virus |
| Overview: Parainfluenza Virus |
| Differential Diagnoses & Workup: Parainfluenza Virus |
 Treatment & Medication: Parainfluenza Virus |
| Follow-up: Parainfluenza Virus |
| References |
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Further Reading
Keywords
parainfluenza virus, human parainfluenza virus, HPIV, HPIV-1, HPIV-2, HPIV-3, HPIV-4, croup, laryngotracheobronchitis, PIV, paramyxoviruses, croup-associated virus, CA virus, Sendai virus, croup, bronchitis, bronchopneumonia, pharyngitis, tracheobronchitis, bronchiolitis, acute respiratory tract infections, pneumonia, respiratory syncytial virus, RSV
