eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease
Parainfluenza Virus Infections: Treatment & Medication
Updated: Aug 28, 2009
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Treatment
Medical Care
Management of croup caused by parainfluenza virus (PIV) infection depends on the severity of disease.
- Prehospital care
- Prehospital care includes fever control and attempts to alleviate respiratory symptoms and patient anxiety.
- Respiratory symptoms commonly improve with benign measures such as sitting in a bathroom with a steaming shower and allowing vapor droplets to soothe inflamed airways. Another option includes exposing the child to the cool night air. Often, the patient's symptoms resolve en route to the hospital. Attempts at calming or distracting the child can be beneficial.
- Antipyretics may assist with fever control. Moderate or severe croup requires medical evaluation in the office or emergency department.
- Emergency department care
- Mild croup: Management of mild croup consists of cool blow-by oxygen mist, fever control, and observation to determine whether the airway appears compromised.
- Moderate croup
- Cool oxygen mist and steroids are common therapies. Controlled trials for the palliation of croup symptoms have yielded conflicting results, and routine use of dexamethasone in this disease remains controversial. Dexamethasone was traditionally intramuscularly administered; however, recent studies have documented the use of oral steroids.
- In patients who fail to improve, administration of racemic epinephrine with a nebulizer has been beneficial. If racemic epinephrine alleviates symptoms, observe the patient for a minimum of 3 hours to ensure the patient's condition does not worsen (eg, due to possible rebound laryngospasm as the racemic epinephrine dose wears off). If asymptomatic at this time, the patient can be discharged with proper follow-up care.
- In patients with moderate croup, oral intake may be lacking; therefore, evaluate the patient's hydration status. Intravenous fluids may be required.
- Severe croup
- Perform the same measures as in moderate croup. Observe for signs of impending respiratory failure.
- Repeat racemic epinephrine nebulization may be needed, in addition to intensive care monitoring. Racemic epinephrine nebulizations can be repeated at 1-hour to 2-hour intervals as needed. Fortunately, fewer than 5% of patients who are admitted require artificial airway support (endotracheal intubation).
Medication
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
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.
Adult
10 mg PO/IV/IM qd
Pediatric
0.6 mg/kg PO/IM qd prn; not to exceed 10 mg/d
Possible decreased effects with coadministration of barbiturates, phenytoin, or rifampin; decreases effect of salicylates and vaccines
Documented hypersensitivity; immunosuppressed patients receiving corticosteroids; varicella
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 hyperthyroidism, osteoporosis, cirrhosis, nonspecific ulcerative colitis, peptic ulcer, diabetes, and myasthenia gravis; tuberculosis; untreated systemic infections; ocular herpes simplex virus
Budesonide (Pulmicort Respules)
Nebulized budesonide has been found to be beneficial in treating croup.
Adult
Not applicable
Pediatric
2-4 mg/d inhaled via nebulizer divided qd/bid
Ketoconazole may increase plasma levels of budesonide; cimetidine may increase bioavailability of budesonide
Documented hypersensitivity; immunosuppressed patients receiving corticosteroids; varicella; patients may develop PO thrush
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
Tuberculosis, untreated systemic infections, ocular herpes simplex virus
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.
Adult
Not applicable
Pediatric
1-2 mg/kg/d PO qd or divided bid
Decreases effects of salicylates and toxoids (for immunizations); phenytoin, carbamazepine, barbiturates, and rifampin decrease effects of corticosteroids
Documented hypersensitivity; immunosuppressed patients receiving corticosteroids; varicella
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 hyperthyroidism, osteoporosis, cirrhosis, nonspecific ulcerative colitis, peptic ulcer, diabetes, and myasthenia gravis; tuberculosis; untreated systemic infections; ocular herpes simplex virus
Bronchodilators
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 solution (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.
Adult
Mix 0.5 mL with 3 mL 0.9% NaCl (normal saline) and inhale via nebulizer q1-2h prn
Pediatric
Mix 0.05 mL/kg with 3 mL 0.9% NaCl (normal saline) and inhale via nebulizer q1-2h prn; not to exceed 0.5 mL/dose
Inhaled anesthetics may enhance cardiac irritability; nonselective beta-blockers block the beta effects of epinephrine leaving unopposed alpha effects (eg, hypertension)
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
Tachycardia, especially with HR >200 BPM; consider cardiac monitoring if multiple doses required
L-epinephrine (Adrenalin)
In concentrations of 1:1000, may be substituted for racemic epinephrine for nebulized administration.
Adult
5 mL nebulized q1-2h prn; mix with 3 mL 0.9% NaCl
Pediatric
<4 years: Mix 2.5 mL with 3 mL 0.9% NaCl (normal saline) and inhale via nebulizer
>4 years: Administer as in adults
Inhaled anesthetics may enhance cardiac irritability; nonselective beta-blockers block the beta effects of epinephrine leaving unopposed alpha effects (eg, hypertension)
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
Tachycardia, especially with HR >200 BPM, consider cardiac monitoring if multiple doses required
More on Parainfluenza Virus Infections |
| Overview: Parainfluenza Virus Infections |
| Differential Diagnoses & Workup: Parainfluenza Virus Infections |
 Treatment & Medication: Parainfluenza Virus Infections |
| Follow-up: Parainfluenza Virus Infections |
| Multimedia: Parainfluenza Virus Infections |
| References |
| « Previous Page | Next Page » |
References
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Further Reading
Keywords
parainfluenza virus infection, PVI, croup, upper respiratory tract infection, laryngotracheobronchitis, URTI, severe acute respiratory syndrome, SARS, pneumonia, parainfluenza virus, coryza, cough, bronchiolitis, paramyxovirus, human bocavirus, treatment, diagnosis
