Aerosolized ribavirin treatment of respiratory syncytial virus infection in infants hospitalized during an epidemic

Conrad, Dennis A.; Christenson, John C.; Waner, Joseph L.; Marks, Melvin I.

doi:10.1097/00006454-198702000-00003

Cited by 61 publications

(14 citation statements)

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“…21,22 It may have a more established role in premature infants or those with congenital heart defects. 23,24 There are to date no prospective randomised studies that enable us to evaluate its role in immunocompromised patients. The use of ribavirin in our unit was neither controlled nor randomised and thus we are unable to come to any conclusion with regard to its efficacy in dealing with this infection.…”

Section: Discussionmentioning

confidence: 99%

The outcome of 26 patients with respiratory syncytial virus infection following allogeneic stem cell transplantation

McCarthy

Kingman

Kelly

et al. 1999

Bone Marrow Transplant

104

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Summary:Respiratory syncytial virus (RSV) is known to cause acute lung injury in the immunocompromised host, especially recipients of bone marrow allografts. Specific prognostic factors for the development of severe lifethreatening disease remain to be identified as does the optimum treatment of established disease. Over a 5-year period the incidence and outcome of RSV in BMT recipients was analysed retrospectively. Prognostic factors assessed included type of transplant, engraftment status at the time of infection, the presence of lower respiratory tract disease, viral genotype and treatment received. During the study period, 26 of 336 (6.3%) allogeneic stem-cell recipients were identified as having RSV. Five patients (19.2%) died as a direct result of RSV. One patient died secondary to an intracranial bleed with concomitant RSV. There were four patients with graft failure (two primary and two secondary) attributable to the presence of RSV, two of whom subsequently died of infections related to prolonged myelosuppression. The presence of lower respiratory tract infection and a poor overall outcome was the only statistically significant association. Unrelated donor transplants and AML as the underlying disease appeared to be associated with a poorer outcome. Engraftment status, viral genotype and RSV treatment received did not correlate with outcome. We conclude that future studies are required to identify early sensitive and reproducible prognostic factors of RSV in the immunocompromised host. The roles of intravenous and nebulised ribavirin need to be clarified by prospective controlled trials.

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Section: Discussionmentioning

confidence: 99%

The outcome of 26 patients with respiratory syncytial virus infection following allogeneic stem cell transplantation

McCarthy

Kingman

Kelly

et al. 1999

Bone Marrow Transplant

104

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“…Numerous blinded trials of RSV-infected patients have demonstrated faster RSV clearance, decreased viral shedding, and shorter hospitalization stays with the use of ribavirin to treat RSV infection (325)(326)(327).…”

Section: Ribavirin As Treatment For Active Rsv Infectionmentioning

confidence: 99%

Respiratory Syncytial Virus: Infection, Detection, and New Options for Prevention and Treatment

2017

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SUMMARY Respiratory syncytial virus (RSV) infection is a significant cause of hospitalization of children in North America and one of the leading causes of death of infants less than 1 year of age worldwide, second only to malaria. Despite its global impact on human health, there are relatively few therapeutic options available to prevent or treat RSV infection. Paradoxically, there is a very large volume of information that is constantly being refined on RSV replication, the mechanisms of RSV-induced pathology, and community transmission. Compounding the burden of acute RSV infections is the exacerbation of preexisting chronic airway diseases and the chronic sequelae of RSV infection. A mechanistic link is even starting to emerge between asthma and those who suffer severe RSV infection early in childhood. In this article, we discuss developments in the understanding of RSV replication, pathogenesis, diagnostics, and therapeutics. We attempt to reconcile the large body of information on RSV and why after many clinical trials there is still no efficacious RSV vaccine and few therapeutics.

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“…Efforts to produce an effective vaccine for prevention of these infections have thus far been unsuccessful (16,19,35). Only recently, with the introduction of ribavirin, has treatment other than supportive therapy been available for children with serious RSV infections (1,6,11,12,29,32).The current studies were prompted by a series of observations: (i) pups of RSV-immune cotton rat mothers were protected from RSV infection, presumably by transplacental antibody (25); (ii) injection of serum from RSV-immune cotton rats protected nonimmune cotton rats from RSV infection (26); (iii) high-titered RSV-immune human serum and human immunoglobulin prepared for intravenous administration (IVIG) were effective for both prophylaxis and therapy of RSV infections in cotton rats and owl monkeys (13, 24); (iv) some lots of human IVIG contained substantial titers of neutralizing antibody to RSV (14); and (v) careful pathological studies of the lungs of RSV-infected animals treated with IVIG revealed no evident microscopic pulmonary abnormalities characteristic of the formation of antigenantibody complexes or other untoward pulmonary reactions (13,24). The current study was designed to determine if IVIG containing substantial levels of RSV-neutralizing antibody could be safely administered and if it would hasten clinical recovery when infused into RSV-infected, hospitalized children.…”

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confidence: 99%

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confidence: 99%

Intravenous immunoglobulin treatment of respiratory syncytial virus infections in infants and young children

Hemming

Rodriguez

Kim

et al. 1987

Antimicrob Agents Chemother

147

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Respiratory syncytial virus (RSV)-infected cotton rats (Sigmadon hispidus) and owl monkeys (Aotus trivirgatus) showed significant reductions in RSV shedding from their respiratory tracts following parenteral therapy with human intravenous immunoglobulin (IVIG) containing high titers of RSV-neutralizing antibody. Because this therapy was well tolerated and appeared safe, a double-blind, placebo-controlled IVIG immunotherapy pilot study was performed on 35 hospitalized, RSV-infected infants and children. The treatment was well tolerated and resulted in significant reductions in nasal RSV shedding and in improvements in transcutaneous oximetry readings. However, the mean duration of hospitalization was not reduced by IVIG treatment. Followup to date has revealed no harmful effects resulting from immunotherapy of RSV infections. These studies appear to refute the hypothesis that passively acquired antibody may exacerbate RSV bronchiolitis or pneumonia in infants. Studies with larger numbers of seriously ill children will be required to determine if immunoglobulin G immunotherapy of RSV infections in infants is of clinical value.Respiratory syncytial virus (RSV) is an important respiratory pathogen of infants and young children. The virus produces annual epidemics of bronchiolitis and pneumonia in children throughout the world and causes numerous hospital admissions, substantial morbidity, and some mortality (2,5,7,15,17,30,31). Efforts to produce an effective vaccine for prevention of these infections have thus far been unsuccessful (16,19,35). Only recently, with the introduction of ribavirin, has treatment other than supportive therapy been available for children with serious RSV infections (1,6,11,12,29,32).The current studies were prompted by a series of observations: (i) pups of RSV-immune cotton rat mothers were protected from RSV infection, presumably by transplacental antibody (25); (ii) injection of serum from RSV-immune cotton rats protected nonimmune cotton rats from RSV infection (26); (iii) high-titered RSV-immune human serum and human immunoglobulin prepared for intravenous administration (IVIG) were effective for both prophylaxis and therapy of RSV infections in cotton rats and owl monkeys (13, 24); (iv) some lots of human IVIG contained substantial titers of neutralizing antibody to RSV (14); and (v) careful pathological studies of the lungs of RSV-infected animals treated with IVIG revealed no evident microscopic pulmonary abnormalities characteristic of the formation of antigenantibody complexes or other untoward pulmonary reactions (13,24). The current study was designed to determine if IVIG containing substantial levels of RSV-neutralizing antibody could be safely administered and if it would hasten clinical recovery when infused into RSV-infected, hospitalized children.

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Aerosolized ribavirin treatment of respiratory syncytial virus infection in infants hospitalized during an epidemic

Cited by 61 publications

References 0 publications

The outcome of 26 patients with respiratory syncytial virus infection following allogeneic stem cell transplantation

The outcome of 26 patients with respiratory syncytial virus infection following allogeneic stem cell transplantation

Respiratory Syncytial Virus: Infection, Detection, and New Options for Prevention and Treatment

Intravenous immunoglobulin treatment of respiratory syncytial virus infections in infants and young children

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