What should be the next treatment for an adult experiencing an asthma exacerbation that is refractory to albuterol?

When an adult is experiencing an asthma exacerbation that does not respond to albuterol, the next appropriate treatment is IV magnesium sulfate. This is due to its ability to relax bronchial smooth muscle and inhibit the release of inflammatory mediators, which can be particularly beneficial during severe asthma attacks. The intravenous administration allows for faster action and is especially useful in cases where other treatments have failed.

Magnesium sulfate acts as a bronchodilator and can help improve airflow, leading to better oxygenation and relief of symptoms.

In contrast, while intravenous corticosteroids may also be part of the management strategy in managing exacerbations, they take time to exert their effects and are typically reserved for ongoing management after initial rescue interventions. Inhaled anticholinergics can complement bronchodilation efforts but are not as effective as magnesium sulfate in this situation. Oral antibiotics would not be indicated in an uncomplicated asthma exacerbation unless there is a suspicion of a bacterial infection, which is not a typical cause of a standard exacerbation.

Thus, IV magnesium sulfate is a critical intervention for acute management of refractory asthma exacerbations.