Thanks James, Ethan, Robert, and others who have graciously responded to my query.
A literature review certainly does remind us of the morbidity associated with RSV coinfection, but also raises questions about WHEN to initiate antibiotic therapy for these inpatients. "In the old days" we would not prophylax if clinical findings indicated straightforward RSV. However I am beginning to question this given several recent uncomfortable surprises we've had.
Are there any thoughts on the list about RSV antibiotic prophylaxis protocols?
James M. Wilson V, M.D.
Delta County Memorial Hospital
Chief of Station
Black Canyon Infectious Disease Forecast Station #1
On Feb 19, 2012, at 3:51 PM, james reingold wrote:
> We're having a very mild RSV season, about 1/2 to 2/3 below last year, which was really rough. Only just starting to see influenza.
> James Reingold, M.D.Mesa, AZ
>> Date: Sat, 18 Feb 2012 09:55:26 -0700
>> From: [log in to unmask]
>> Subject: Re: RSV Co-Infection Rates
>> To: [log in to unmask]
>> Nearly identical situation in Tulsa, OK.
>> Started the second week of January.
>> ED volume up 100% over the same weeks last year... many days with a full hospital and boarding pts in the ED.
>> Quite a bit of co-infection (mostly adeno and hMPV). Very little influenza.
>> Increased overall severity of disease with a more debilitating illness in older children than we've seen historically (several two/three olds have required intubation). The degree of hypoxia and respiratory distress in previously healthy toddlers has been quite surprising.
>> Sent from my iPhone
>> On Feb 17, 2012, at 9:33 PM, James Wilson <[log in to unmask]> wrote:
>>> Right on cue per our infectious disease forecast station's advisory, we are seeing RSV. Quite the abrupt 'pop' of RSV, with both volume and clinical severity involving several 2 year olds versus infants. Beyond the obvious difference from baseline we are observing in our locality, we have noticed several children who were well on the way to recovery and discharge… only to rapidly deteriorate. We have been seeing co-infection of RSV and H. flu, and others in our area of the country have noted RSV-adeno, RSV-influenza, and RSV-hMPV. This is all interesting when considering this situation now is producing near-diversion-level strain on several hospitals… and this is not influenza type A.
>>> Anyone else out there seeing the same thing?
>>> Jim Wilson, M.D.
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