Viral Bronchiolitis in Infants in the Era of Targeted Therapies: What Now and What's Next?

BACKGROUND

Viral bronchiolitis is the most common cause of lower respiratory tract infection in infants and the leading cause of hospitalization in infants under 1 year of age. Most clinical practice guidelines (CPGs) recommend a minimalist management approach based on supportive therapy, focusing solely on maintaining oxygenation and hydration.

OBJECTIVES

To examine the reasons behind the poor adherence to evidence-based guidelines for bronchiolitis in real-world clinical practice and to explore potential strategies to improve future management.

METHODS

This narrative review discusses factors that may explain the observed gap between guideline recommendations and clinical practice, including recent findings from the field that help clarify this poor adherence.

RESULTS

We highlight the discrepancy between guideline-based recommendations and clinical implementation. We also discuss the evolving landscape of bronchiolitis management, including evidence supporting novel interventions such as maternal RSV vaccination during pregnancy and the use of monoclonal antibodies like nirsevimab and ziresovir, an oral RSV F protein inhibitor.

CONCLUSIONS

Understanding and addressing the causes of poor adherence to bronchiolitis guidelines is critical. Future research should aim to integrate evidence-based treatments with options for personalized adjustments. Updated guidelines should reflect emerging interventions and provide rational management pathways until robust evidence from new studies becomes available.

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