As winter approaches, we are witnessing a rise in respiratory illnesses among children in hospital wards and daily medical practice. Among these cases, bronchiolutis stands out as a significant concern in infants and young children.
Recent media reports indicate a surge in pneumonia cases across Bangladesh. However, this raises a critical question: could many of these cases actually be bronchiolitis? Based on recent observations, bronchiolitis appears to be more prevalent than pneumonia among young children. Unfortunately, frequent misdiagnoses of bronchiolitis as pneumonia result in unnecessary antibiotic prescriptions, further exacerbating the growing problem of antibiotic resistance.
Current data indicates that 60-80 per cent of commonly prescribed antibiotics in Bangladesh are no longer effective, as documented by sensitivity reports. This alarming trend of resistance poses a significant public health challenge, threatening to severely limit treatment options in the future.
Another troubling issue is the improper use of antibiotics, especially in rural areas where unqualified drug sellers often administer potent antibiotics, such as meropenem and vancomycin, without a doctor's prescription. This unsafe practice, commonly observed in local shops, not only accelerates the development of antibiotic resistance but also endangers the health of children.
From a financial perspective, the disparity in treatment costs between bronchiolitis and pneumonia is significant. Bronchiolitis can often be effectively managed with nebulization using 3 per cent or 7 per cent hypertonic saline, costing about 10 taka. In contrast, a misdiagnosis leading to pneumonia treatment can result in antibiotic costs of up to 1,500 taka, along with the additional public health burden of increasing antibiotic resistance.
Bronchiolitis is relatively straightforward to diagnose. Babies with this condition, despite symptoms like coughing, cold, and respiratory distress accompanied by a characteristic wheeze, often remain in good spirits overall. Chest X-rays typically confirm the diagnosis, showing signs of hyperinflation and increased lung translucency.
Accurate differentiation between bronchiolitis and pneumonia is crucial to prevent unnecessary treatments, reduce healthcare costs, and curb the growing issue of antibiotic resistance. It is important to recognise that not all cases of cough, cold, or breathing difficulty are due to pneumonia. In fact, most are cases of bronchiolitis, which is not only simpler to diagnose but also far more cost-effective to treat.
Rahat Bin Habib
Assistant Professor (Pediatrics)
Saheed Sayed Nazrul Islam Medical College
Kishoreganj
[email protected]
