Ribavirin for respiratory syncytial virus infection of the lower respiratory tract

Abstract

Objectives: Respiratory syncytial virus (RSV) is a common cause of pneumonia in infants. Ribavirin is the only antiviral therapy available against RSV. The objective of this review was to assess the effects of aerosolized ribavirin for infants with RSV lower respiratory tract infection.

Search strategy: We searched MEDLINE from 1975 to 1999, we scanned reference lists of articles, and we contacted experts in the field.

Selection criteria: Randomized trials comparing ribavirin with placebo in infants and children with RSV infection and lower respiratory tract infection.

Data collection and analysis: Two reviewers independently extracted data and assessed trial quality. Unpublished data were requested from authors when necessary.

Main results: Ten trials were included. All trials enrolled infants below the age of six months. In four trials with 158 patients, mortality with ribavirin was 5.8% compared with 9.7% with placebo (odds ratio 0.58, 95% confidence interval 0.18 to 1.85). In three trials with 116 patients the probability of respiratory deterioration with ribavirin was 7.1% compared with 18.3% with placebo (odds ratio 0.37, 95% confidence interval 0.12 to 1.18). In three studies with 104 patients the weighted mean difference in days of hospitalization was 1.9 fewer days with ribavirin (95% confidence interval +0.9 to -4.6) and the difference in days of ventilation was 1.2 fewer days with ribavirin (95% confidence interval -0.2 to -3.4).

Reviewer's conclusions: Trials of ribavirin for RSV lack sufficient power to provide reliable estimates of the effects. The cumulative results of three small trials show that ribavirin reduces length of mechanical ventilator support and may reduce days of hospitalization. A large randomized controlled trial of ribavirin for ventilated and other high-risk patients is indicated.