Pediatric Parainfluenza Virus Infections Medication
- Author: Roy M Vega, MD; Chief Editor: Russell W Steele, MD more...
Medication Summary
No specific antiviral agents are available for treating parainfluenza virus (PIV) infections; however, medications are available to treat the respiratory symptoms associated with croup. The medications include corticosteroids and nebulized epinephrine to treat airway inflammation and edema.
Glucocorticoids
Class Summary
These agents 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 delayed onset of action, the high potency and prolonged intramuscular half-life of dexamethasone make it the preferred corticosteroid for croup.
Dexamethasone (Decadron)
Criterion standard anti-inflammatory drug for reducing airway edema that occurs in croup. Other glucocorticoids have been used, including prednisone and prednisolone. Dexamethasone is thought to decrease inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.
Budesonide inhaled (Pulmicort Respules)
Nebulized budesonide has been found to be beneficial in treating croup.
Prednisolone (Delta-Cortef, Pediapred)
Many practitioners administer liquid prednisolone for patients with croup in lieu of dexamethasone. Prednisolone has not been proven superior to dexamethasone.
Bronchodilators
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 in comparison with oral or parenteral administration.
Epinephrine racemic (Vaponefrin, microNefrin)
Very effective in reversing upper airway edema when administered with a nebulizer. Proposed mechanism of action is alpha-adrenergic receptor-mediated vasoconstriction of edematous tissues.
L-epinephrine (Adrenalin)
In concentrations of 1:1000, may be substituted for racemic epinephrine for nebulized administration.
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