Early ribavirin treatment of respiratory syncytial viral infection in high-risk children

Patients with multiple myeloma may safely undergo autologous transplantation despite ongoing RSV infection and no ribavirin therapy

“…46 We submit that, like in children, aerosolized ribavirin is of limited usefulness in adult transplant recipients for the following reasons: (1) The most recent and larger trials (including 2206 patients) of the treatment of RSV infections in infants concluded that aerosolized ribavirin was detrimental because of prolonged hospitalization, ICU stay or prolonged oxygenation and worsening pulmonary functions in those patients who received ribavirin. [20][21][22]24 By contrast, the trials that support the use of ribavirin included a very small number of patients (a total of 188 patients) [7][8][9][10][11][12] or used water installation in the placebo arm. 13 It is important to stress, however, that the above-mentioned trials were also conducted in pediatric patients.…”

“…6 However, this approach has never been evaluated in randomized trials in adults. The trials in pediatric RSV infections gave conflicting results: some showing clinical improvement, [7][8][9][10][11][12][13] while others showed no benefit [14][15][16][17][18] or even a detrimental effect (eg prolonged duration of hospitalization, intensive care unit stay, duration of hypoxia, and mechanical ventilation) [19][20][21][22][23][24] (Table 1). A recent metaanalysis of randomized trials concluded that the administration of ribavirin in pediatric RSV infections is not supported by the clinical studies and does not result in decreases in length of hospital stay or mortality rate.…”

Aerosolized Ribavirin in the Treatment of Respiratory Syncytial Viral Infection in Children: A Meta-Analysis

“…Eight out of fourteen identified clinical trials were included in the analysis. [17][18][19][20][21][22][23][24] One of the trials included was an abstract. 24 Six studies were excluded for the following reasons: absence of a placebo group, 25 inadequate reporting of data, 26 pulmonary function results being the only outcome, 27 IgA and IgE responses being the only outcome, 28 inclusion of only adult patients, 29 outcome measured was different from those of other studies, and inclusion of patients who were RSV negative.…”

“…In ventilated patients, the treatment was given for five days in one study 23 and for seven days in the other study, 22 or until extubation if that occurred first. Two studies used aerosolized normal saline 18,23 and six studies 17,[19][20][21][22][23][24] used aerosolized water as placebo. Three trials in non-ventilated patients [17][18][19] did not state the method used to ensure blinding of the outcome assessor(s).…”

“…Three trials in non-ventilated patients [17][18][19] did not state the method used to ensure blinding of the outcome assessor(s). In one study, 21 a blinded physician used observations by therapists to assign clinical scores during the period of home therapy for a sub-group treated at home, but this may also have been biased. In studies on ventilated patients, 22,23 the respiratory therapists cleaned the ventilation circuits before the clinical assessment by a physician.…”