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Published on: December 10, 2013
Ribavirin for respiratory syncytial virus lower respiratory tract infection. A systematic overview
1Department of Pediatrics, University of California, San Francisco, USA.
Insights
Aerosolized ribavirin shows no significant benefit for infants with respiratory syncytial virus lower respiratory tract infection. Further research is needed to determine its potential impact on mortality and respiratory deterioration in high-risk infants.
Area of Science:
- Pediatric Infectious Diseases
- Respiratory Medicine
- Pharmacological Efficacy Studies
Background:
- Respiratory syncytial virus (RSV) lower respiratory tract infection (LRTI) is a significant cause of infant morbidity.
- Aerosolized ribavirin has been investigated as a treatment for severe RSV LRTI.
Purpose of the Study:
- To systematically review the evidence on the efficacy of aerosolized ribavirin for treating infants with RSV LRTI.
Main Methods:
- A comprehensive literature search of MEDLINE and reference lists was conducted.
- Eight double-blind randomized placebo-controlled trials involving infants with documented RSV LRTI were included.
- Study quality and data on outcomes were independently assessed by two reviewers.
Main Results:
- Meta-analysis of three trials showed no significant reduction in mortality rate (RR = 0.42, 95% CI = 0.13, 1.44) or respiratory deterioration (RR = 0.42, 95% CI = 0.16, 1.34), despite trends favoring benefit.
- No studies demonstrated a shortened hospital stay.
- Results regarding ventilation duration and oxygen supplementation were inconsistent.
Conclusions:
- Current evidence does not support the use of aerosolized ribavirin for infants with RSV LRTI due to a lack of significant benefit.
- Existing studies may lack the statistical power to definitively exclude a reduction in mortality or respiratory deterioration.
- A large randomized controlled trial is recommended for ventilated and high-risk infants.
Objective:
To systematically review the evidence evaluating the efficacy of aerosolized ribavirin for the treatment of infants with respiratory syncytial virus lower respiratory tract infection.
Design:
A computerized search of MEDLINE from 1975 to the present, a review of the reference lists of each retrieved article, and contact with experts.
Patients:
infants with documented respiratory syncytial virus lower respiratory tract infection who were the subjects of 8 double-blind randomized placebo-controlled trials.
Methods:
Two independent reviewers assessed study quality and extracted data on the study populations, the drug regimens, and clinically relevant outcome measurements.
Results:
Ribavirin does not significantly reduce mortality rate (relative risk [RR] = 0.42, 95% confidence interval [CI] = 0.13, 1.44) or lower the probability of respiratory deterioration (RR = 0.42, 95% CI = 0.16, 1.34) when meta-analysis is used to pool the outcomes of 3 trials, although strong trends in the direction of benefit are present. No study found ribavirin to shorten length of hospitalization. Results on length of ventilation and oxygen supplementation are conflicting.
Conclusions:
Use of ribavirin in infants with respiratory syncytial virus lower respiratory tract infection is not supported by evidence of significant benefit. However, previous studies lack sufficient power to rule out a potential reduction in mortality rate or respiratory deterioration. A large randomized controlled trial of ribavirin for ventilated and other high-risk patients is needed.
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