Ribavirin Aerosol

Therapy of infants with respiratory syncytial virus infections was studied in double-blind randomized trials. Using the aerosol 12hr/day, infants improved more rapidly than controls, but viral shedding was similar in both groups [204]. When used for 20hr/day, treated infants improved more rapidly than controls with respect to severity of illness, oxygen saturation, and viral shedding [205]. Knight and colleagues [206] estimated that a useful quantity of drug was retained for 3 days after a 23-hr/day treatment.

Ribavirin seems to be effective, but the lengthy administration that has been used is a disadvantage. There is now evidence that shorter courses (two hours three times per day) of ribavirin are as useful as standard therapy (18 hours per day) [207]. Aerosolized ribavirin has been used with variable success for children ventilated for bronchiolitis caused by RSV [208-210]. The more recent evidence casts some doubt on the efficacy of this aerosol treatment. Ribavirin aerosol has also been used for treatment or prophylaxis following bone marrow transplantation [211,212], but controlled trials are needed to better clarify efficacy. Considering the magnitude of this problem, definitive trials to clearly define efficacy would be welcome.

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