Which antiviral therapy is used for bronchiolitis in severe cases?

• A. Acyclovir
• B. Ribavirin with SPAG
• C. Oseltamivir
• D. Lamivudine

Answer: (B)

Ribavirin delivered as an inhaled aerosol (often using a small particle aerosol generator, SPAG) is used for severe RSV bronchiolitis in high-risk infants. RSV is the main cause of bronchiolitis, and in kids with severe disease or significant comorbidities, antiviral therapy with aerosolized ribavirin can help by inhibiting viral RNA synthesis in the respiratory tract. This approach is reserved for severe cases because of safety concerns and variable evidence of benefit, so it isn’t used for routine bronchiolitis.

Acyclovir targets herpesviruses, not RSV. Oseltamivir is for influenza viruses. Lamivudine treats HIV and hepatitis B, not RSV bronchiolitis. Therefore, the inhaled ribavirin via SPAG is the best choice for severe cases.