Ribavirin(Rib) Therapy Of Respiratory Syncytial Virus (Rsv) Infection In Infants With Cardiopulmonary Disease

Aerosolized Rib has appeared beneficial in the treatment of RSV pneumonia in selected normal infants in a previous study. We have since evaluated Rib therapy of RSV lower respiratory tract infection (LRI) in infants with underlying cardiopulmonary disease to determine its efficacy and safety in such high risk infants. 22 infants with RSV LRI were studied in '83–84 in a randomized double-blind manner to receive aerosolized Rib (12) or placebo (10) (water) An additional 20 infants with life-threatening illness were not randomized, but treated with Rib. 26 infants (10 randomized, 16 non-randomized) had bronchopulmonary dysplasia or congenital heart disease. The 22 randomized infants received Rib or placebo for 21 hrs/d for 3–8days(mean=5d) and were matched in age (15wks), sex, underlying disease, duration of illness before therapy and severity of illness on admission. At start of therapy Rib infants had greater illness severity scores by double blind exam than placebo pts (p.06). But Rib pts showed faster and greater improvement by d.3 (p<.01), d 4 and end of Rx (p=.002). Arterial oxygen saturations determined daily also improved more in Rib pts (p<.05). Daily quantitation of viral shedding showed significantly lower titers in Rib pts on d 5,6 (p<.03) and % of Rib pts still shedding was less on d5 (p=.04) & d.6 (p=.007). The 20 non-randomized infants (mean age 25 wks) were treated with Rib for 4–22days. 15(75%) required respirators. Viral shedding ceased in all ≤ 6 d from start of Rib. All but one recovered from acute infection; 3 others died > 1 month later.