Intravenous ribavirin for respiratory syncytial viral infections in pediatric hematopoietic SCT recipients

Abstract

A Molinos-Quintana, C Pé rez-de Soto, M Gó mez-Rosa, JA Pé rez-Simó n and JM Pé rez-HurtadoRespiratory syncytial virus (RSV) is a potential cause of serious morbidity and even mortality among children undergoing hematopoietic SCT (HSCT). Contrary to the available information regarding the aerosolized formulation of ribavirin, there is a paucity of published studies using i.v. ribavirin in adults, and very few single reports on pediatric patients. Aerosolized drug administration has been limited by potential toxicity and special air-flow requirements. In this regard, i.v. ribavirin could prevent these disadvantages, but its efficacy and safety remain controversial in the pediatric HSCT setting. The present study describes the outcome of six pediatric patients undergoing HSCT with nine episodes of proven RSV. Four episodes corresponded to lower respiratory tract infection (LRTI) and five presented with upper respiratory tract infection (URTI). All LRTI patients showed favorable clinical responses, with 100% survival and no progression to LRTI in the remaining five URTI. No side effects were documented during ribavirin administration. We conclude that ribavirin was well tolerated intravenously, without associated side effects, and was effective in the treatment of RSV in this limited number of pediatric HSCT patients. The role and efficacy of i.v. ribavirin needs to be further clarified by prospective controlled trials in pediatric populations.

Management of Respiratory Viral Infections in Hematopoietic Cell Transplant Recipients and Patients With Hematologic Malignancies

“…Similar findings have been reported in other studies, in which a lack of aerosolized ribavirin increased the risk of mortality in HCT recipients with RSV lower respiratory tract disease [18,22] (Figure 1). A small case series described the tolerability and success of intravenous ribavirin in the treatment of 6 pediatric HCT recipients in preventing LRTI and mortality following RSV infection [24]. Similarly, intravenous and oral ribavirin were efficacious in preventing RSV LRTI in 10 adult HCT recipients with severe lymphocytopenia [25].…”

Viral Respiratory Tract Infections After Hematopoetic Stem Cell Transplantation in Pediatric Patients

“…Prolonged wheeze, fever and cough can be observed when compared to other viral factors. The progression of the disease to the lower respiratory tract in HSCT patients may result in high mortality rates (9%-29%) (2,15,25,28). The infection is generally limited to the respiratory system; however, there are cases reporting heart and liver involvement (29).…”

Influenza and other respiratory virus infections in solid organ transplant recipients

“…Appropriate precautions should be taken to avoid environmental teratogenic exposure in pregnant healthcare workers and visitors when aerosolized ribavirin is used. A few reports have reported the use of systemic ribavirin for RSV disease: orally or intravenously as 10–30 mg/kg of body weight in three divided doses . Patients treated with systemic ribavirin should be checked for haemolysis, abnormal liver function and kidney failure.…”