Human Parainfluenza Viruses (HPIV) and Other Parainfluenza Viruses Medication

Updated: Mar 19, 2019
  • Author: Subhash Chandra Parija, MD, MBBS, PhD, DSc, FRCPath; Chief Editor: Mark R Wallace, MD, FACP, FIDSA  more...
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Medication

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.

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Corticosteroids

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

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.

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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.

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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.

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