Prospective Follow-up and Pulmonary Functions From a Placebo-Controlled Randomized Trial of Ribavirin Therapy in Respiratory Syncytial Virus Bronchiolitis

Rodríguez, William J.; Arrobio, Julita O.; Fink, Robert; Kim, Hyun W.; Milburn, Cherye

doi:10.1001/archpedi.153.5.469

Cited by 47 publications

(31 citation statements)

References 17 publications

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“…[86][87][88][89][90][91][92][93][94] Two evaluated the effect on long-term wheezing and/or pulmonary function. 95,96 Three additional studies were identified with similar results. Two of these evaluated effectiveness in the acute phase 97,98 and one on subsequent respiratory status.…”

Section: Recommendation 4 Ribavirin Should Not Be Used Routinely In Cmentioning

confidence: 86%

“…96 Two others were follow-up studies of previous randomized trials and measured subsequent pulmonary function as well as wheezing episodes. 95,99 The first study 96 found fewer episodes of wheezing and infections in the ribavirin-treated patients, and the latter 2 studies 95,99 found no significant differences between groups. No randomized studies of other antiviral therapies of bronchiolitis were identified.…”

mentioning

confidence: 98%

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Diagnosis and Management of Bronchiolitis

2006

Pediatrics

879

293

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Bronchiolitis is a disorder most commonly caused in infants by viral lower respiratory tract infection. It is the most common lower respiratory infection in this age group. It is characterized by acute inflammation, edema, and necrosis of epithelial cells lining small airways, increased mucus production, and bronchospasm.The American Academy of Pediatrics convened a committee composed of primary care physicians and specialists in the fields of pulmonology, infectious disease, emergency medicine, epidemiology, and medical informatics. The committee partnered with the Agency for Healthcare Research and Quality and the RTI International-University of North Carolina Evidence-Based Practice Center to develop a comprehensive review of the evidence-based literature related to the diagnosis, management, and prevention of bronchiolitis. The resulting evidence report and other sources of data were used to formulate clinical practice guideline recommendations.This guideline addresses the diagnosis of bronchiolitis as well as various therapeutic interventions including bronchodilators, corticosteroids, antiviral and antibacterial agents, hydration, chest physiotherapy, and oxygen. Recommendations are made for prevention of respiratory syncytial virus infection with palivizumab and the control of nosocomial spread of infection. Decisions were made on the basis of a systematic grading of the quality of evidence and strength of recommendation. The clinical practice guideline underwent comprehensive peer review before it was approved by the American Academy of Pediatrics.This clinical practice guideline is not intended as a sole source of guidance in the management of children with bronchiolitis. Rather, it is intended to assist clinicians in decision-making. It is not intended to replace clinical judgment or establish a protocol for the care of all children with this condition. These recommendations may not provide the only appropriate approach to the management of children with bronchiolitis. INTRODUCTIONTHIS GUIDELINE EXAMINES the published evidence on diagnosis and acute management of the child with bronchiolitis in both outpatient and hospital settings, including the roles of supportive therapy, oxygen, bronchodilators, antiinflammatory agents, antibacterial agents, and antiviral agents and make recommendations to influence clinician behavior on the basis of the evidence. Methods of prevention All clinical practice guidelines from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.The recommendations in this guideline do not indicate an exclusive course of treatment or serve as a standard of care. Variations, taking into account individual circumstances, may be appropriate. Key Word bronchiolitisAbbreviations CAM-complementary and alternative medicine LRTI-lower respiratory tract infection AHRQ-Agency for Healthcare Research and Quality RSV-respiratory syncytial virus AAP-American Academy of Pediatrics AAFP-American Academy...

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Section: Recommendation 4 Ribavirin Should Not Be Used Routinely In Cmentioning

confidence: 86%

mentioning

confidence: 98%

Diagnosis and Management of Bronchiolitis

2006

Pediatrics

879

293

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“…Similarly, KRILOV et al [93] found no statistically significant difference in reactive airway disease between treatment groups, 5-6 yrs after RSV bronchiolitis. In contrast, a prospective 5-7-yr follow-up study by RODRIGUEZ et al [94] of a placebo-controlled randomized trial suggested that ribavirin provides a longterm benefit versus placebo. A follow-up by EDELL et al [95] also suggested that ribavirin treatment of RSV bronchiolitis could reduce the prevalence of subsequent reactive airway disease.…”

Section: Antiviral Treatmentmentioning

confidence: 93%

Relationship between respiratory syncytial virus bronchiolitis and future obstructive airway diseases

Wennergren¹,

Kristjánsson²

2001

European Respiratory Journal

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Relationship between respiratory syncytial virus bronchiolitis and future obstructive airway diseases. G. Wennergren, S. Kristjánsson. #ERS Journals Ltd 2001. ABSTRACT: Evidence from a large number of prospective case-control studies shows that respiratory syncytial virus (RSV) bronchiolitis in infancy is often associated with recurrent wheezing and asthma during subsequent years. However, wheezing tends to diminish and most studies show no significant increase in wheezing compared to controls by school age or adolescence. An unresolved question is whether severe RSV infection during infancy causes the respiratory sequelae or inherent abnormalities predispose an infant to develop severe respiratory infection and sequelae, i.e. RSV is associated with the development of pulmonary sequelae.Studies on long-term outcome of RSV bronchiolitis are reviewed from an evidencebased perspective.The majority of prospective placebo-controlled studies do not show any long-term beneficial effects of corticosteroid treatment, i.e. the risk of subsequent wheezing is not diminished by the treatment. The evidence for an increased risk of allergic sensitization after RSV bronchiolitis is not nearly as strong as the evidence for an increased risk of subsequent wheezing. In fact, most studies do not show any significant increase in atopy after RSV bronchiolitis. This suggests that the increased risk of wheezing after RSV is not linked to an increased risk of atopy. There are some indications that infants who develop severe RSV and subsequent wheezing may have aberrations that predate the RSV infection.To decide whether respiratory syncytial virus bronchiolitis causes, or is associated with the respiratory sequelae (or with subsequent allergy), it will be necessary to conduct prospective, randomized studies, where the cytokine profile prior to bronchiolitis onset is known. Such studies should preferably include some form of intervention against respiratory syncytial virus. A more complete understanding of the risk factors for severe respiratory syncytial virus infection and the role of respiratory syncytial virus infection in the initiation of asthma is needed as a basis for large-scale and cost-effective programmes to prevent respiratory syncytial virus-related morbidity. Eur Respir J 2001; 18: 1044-1058. Respiratory syncytial virus (RSV) bronchiolitis is the most common, severe lower respiratory tract infection in infancy. It now seems well established that RSV bronchiolitis in infancy is associated with recurrent wheezing and asthma during the first decade of life. In some children, wheezing after early lower airway infection with RSV is transient, but in many of the children RSV-induced bronchiolitis represents the onset of asthma. In fact, there are results which indicate that severe RSV bronchiolitis in the young infant may shift the T-helper (Th)1/Th2 balance in favour of a Th2 cytokine pattern, leading to development of allergic sensitization and persistent asthma [1,2]. However, the association with risk of development of atopy...

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“…However, data support both concepts in part. Follow-up studies of children who received ribavirin therapy for RSV infection have been inconclusive; some studies showed long-term pulmonary benefits [19,20], whereas others have not confirmed this observation [21,22]. Future studies in this area, including follow-up of patients who have received RSV prophylaxis, should yield important information on this issue.…”

Section: Long-term Outcomementioning

confidence: 99%

Respiratory syncytial virus: Update on infection, treatment, and prevention

Krilov

2001

Curr Infect Dis Rep

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Respiratory syncytial virus (RSV) infection, which primarily manifests as bronchiolitis or pneumonia, is the leading cause of lower respiratory tract infection in infants and young children. It is associated with more than 100,000 pediatric hospitalizations each year in the United States. Infants who were premature; have chronic lung disease, congenital heart disease, or immunodeficiency disorders; or have underlying metabolic or neuromuscular disorders are at increased risk for especially severe RSV disease. Treatment of children hospitalized with RSV disease is primarily supportive, with administration of supplemental oxygen and fluid replacement therapy. Bronchodilators may benefit at least a subset of such patients. Antiviral therapy with aerosolized ribavirin is available for high-risk, severely ill patients. Handwashing, cleaning of environmental surfaces, and cohorting in hospital settings may decrease RSV transmission. In children born premature and younger than 1 year of age, and in patients with bronchopulmonary dysplasia younger than 2 years of age, passive protection against severe RSV disease may be achieved through monthly injections of anti-RSV antibody (palivizumab) during winter months. No vaccine is available to provide active immunity against RSV, but live attenuated and subunit cloned surface protein vaccines are in development.

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Prospective Follow-up and Pulmonary Functions From a Placebo-Controlled Randomized Trial of Ribavirin Therapy in Respiratory Syncytial Virus Bronchiolitis

Abstract: Editor's Note: I've always been surprised that many (most?) physicians believe that the use of ribavirin is based on its safety, which has not been the case. Perhaps this study, added to several others, will convince them.

Cited by 47 publications

References 17 publications

Diagnosis and Management of Bronchiolitis

Diagnosis and Management of Bronchiolitis

Relationship between respiratory syncytial virus bronchiolitis and future obstructive airway diseases

Respiratory syncytial virus: Update on infection, treatment, and prevention

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