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Article
September 1996

Ribavirin for Respiratory Syncytial Virus Lower Respiratory Tract InfectionA Systematic Overview

Author Affiliations

From the Department of Pediatrics, Division of Pediatric Critical Care, Institute for Health Policy Studies, University of California, San Francisco (Dr Randolph); and the Clinical Epidemiology Unit, The Hospital for Sick Children, Clinical Epidemiology and Health Care Research Program and Department of Pediatrics, University of Toronto, Ontario (Dr Wang).

Arch Pediatr Adolesc Med. 1996;150(9):942-947. doi:10.1001/archpedi.1996.02170340056011
Abstract

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.Arch Pediatr Adolesc Med. 1996;150:942-947

References
1.
American Academy of Pediatrics Committee on Infectious Diseases.  Use of ribavirin in the treatment of respiratory syncytial virus infection . Pediatrics . 1993;92:501-504.
2.
Zucker AR, Meadow WL.  Pediatric critical physicians' attitudes about guidelines for the use of ribavirin in critically ill children with respiratory syncytial virus pneumonia . Crit Care Med . 1995;23:767-772.Article
3.
Law BJ, DeCarvalho V.  Respiratory syncytial virus infections in hospitalized Canadian children: regional differences in patient population and management practices . Pediatr Infect Dis J . 1993;12:659-663.Article
4.
Wald ER, Dashefsky B.  Ribavirin: Red Book Committee recommendations questioned . Pediatrics . 1994;94:672-673.
5.
Turner RB.  Red Book Committee recommendations on ribavirin challenged . Pediatrics . 1994;93:873.
6.
Wald ER, Dashefsky B, Green M.  In re ribavirin: a case of premature adjudication? J Pediatr . 1988;112:154-158.Article
7.
Decker JA, Shultz RA.  Interim report . In: Hazard Evaluation and Technical Assistance . Washington, DC: NIOSH; 1992.
8.
McBride JT.  Study design considerations for ribavirin: efficacy studies . Pediatr Infect Dis J . 1990;9( (suppl) ):S74-S78.Article
9.
Cook DJ, Sackett DL, Spitzer WO.  Methodological guidelines for systematic reviews of randomized control trials in health care from the Potsdam Consultation on Meta-Analysis . J Clin Epidemiol . 1995;48:167-171.Article
10.
Oxman A.  Preparing and maintaining systematic reviews . In: Sackett DL, ed. The Cochrane Collaboration Handbook . Oxford, England: Cochrane Collaboration; 1994.
11.
International Agency for Research on Cancer. Statistical Methods in Cancer Research . Lyons, France: IARC Scientific Publications; 1980:1. IARC publication 32.
12.
Bracken MB.  Statistical methods for analysis of effects of treatment in overviews of randomized trials . In: Sinclair JC, Bracken MB, eds. Effective Care of the Newborn Infant . Oxford, England: Oxford University Press; 1992:13-18.
13.
Thompson SG, Pocock SJ.  Can meta-analyses be trusted? Lancet . 1991;338: 1127-1130.Article
14.
Smith DW, Frankel LR, Mathers LH, Tang AT, Ariagno RL, Prober CG.  A controlled trial of aerosolized ribavirin in infants receiving mechanical ventilation for severe respiratory syncytial virus infection . N Engl J Med . 1991;325:24-29.Article
15.
Taber LH, Knight V, Gilbert BE, et al.  Ribavirin aerosol treatment of bronchiolitis associated with respiratory syncytial virus infection in infants . Pediatrics . 1983;72:613-618.
16.
Rodriguez WJ, Kim HW, Brandt CD, et al.  Aerosolized ribavirin in the treatment of patients with respiratory syncytial virus disease . Pediatr Infect Dis J . 1987;6:159-163.Article
17.
Meert KL.  Aerosolized ribavirin in mechanically ventilated children with respiratory syncytial virus lower respiratory tract disease: a prospective, double-blind, randomized trial . Crit Care Med . 1994;22:566-572.Article
18.
Janai HK, Harris HR, Zaleska M, et al.  Ribavirin effect on pulmonary function in young infants with respiratory syncytial virus bronchiolitis . Pediatr Infect Dis J . 1993;12:214-218.Article
19.
Hall CB, McBride JT, Walsh EE, et al.  Aerosolized ribavirin treatment of infants with respiratory syncytial viral infection: a randomized double-blind study . N Engl J Med . 1983;308:1443-1447.Article
20.
Hall CB, McBride JT, Gala CL, Hildreth SW, Schnabel KC.  Ribavirin treatment of respiratory syncytial viral infection in infants with underlying cardiopulmonary disease . JAMA . 1985;254:3047-3051.Article
21.
Groothuis JR, Woodin KA, Katz R, et al.  Early ribavirin treatment of respiratory syncytial viral infection in high risk children . J Pediatr . 1990;117:792-798.Article
22.
Englund JA, Piedra PA, Ahn YM, Gilbert BE, Hiatt P.  High-dose, short-duration ribavirin aerosol therapy compared with standard ribavirin therapy in children with suspected respiratory syncytial virus infection . J Pediatr . 1994;125:635-641.Article
23.
Rosner IK, Welliver RC, Edelson PJ, Geraci-Ciardullo K, Sun M.  Effect of ribavirin therapy on respiratory syncytial virus-specific IgE and IgA responses after infection . J Infect Dis . 1987;155:1043-1047.Article
24.
Edelson PJ.  Clinical studies with ribavirin . Pediatr Infect Dis J . 1990;9( (suppl) ): S71-S73.Article
25.
Barry W, Cockburn F, Cornall R, Price JF, Sutherland G, Vardag A.  Ribavirin aerosol for acute bronchiolitis . Arch Dis Child . 1986;61:593-597.Article
26.
Moler FW, Bandy KP, Custer JR.  Ribavirin for severe RSV infection . N Engl J Med . 1991;325:1884-1885.Article
27.
Sullivan BJ.  A controlled trial of aerosolized ribavirin in infants receiving mechanical ventilation for severe respiratory syncytial virus infection . N Engl J Med . 1991;325:1885.Article
28.
Stretton M, Ajizian SJ, Mitchell I, Newth CJL.  Intensive care course and outcome of patients infected with respiratory syncytial virus . Pediatr Pulmonol . 1992;13:143-150.Article
29.
Baba Y, Hayashida M, Yasunami J, Takamatsu I, Adachi K, Toyoshima K.  Bronchoconstrictive effect of ultrasonic nebulized distilled water on asthmatic children . J Asthma . 1989;26:299-307.Article
30.
Cheney FW, Butler J.  The effects of ultrasonically-produced aerosols on airway resistance in man . Anesthesiology . 1968;29:1099-1106.Article
31.
Sheppard D, Rizk NW, Boushey HA, Bethel RA.  Mechanism of cough and bronchoconstriction induced by distilled water aerosol . Am Rev Respir Dis . 1983; 127:691-694.
32.
McBride JT, Wooden KA, Katz R, et al.  Ribavirin therapy for acute bronchiolitis: need for appropriate controls . J Pediatr . 1991;119:510.Article
33.
American Academy of Pediatrics Committee on Infectious Diseases.  Reassessment of the indications for ribavirin therapy in respiratory syncytial virus infections . Pediatrics . 1996;97:137-140.
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