This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

A Systematic Overview

Adrienne G. Randolph, MD; Elaine E. L. Wang, MD, MSc

Arch Pediatr Adolesc Med. 1996;150(9):942-947.

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

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).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Lower Respiratory Viral Illnesses: Improved Diagnosis by Molecular Methods and Clinical Impact
Garbino et al.
Am. J. Respir. Crit. Care Med. 2004;170:1197-1203.
ABSTRACT | FULL TEXT  

Animal Pneumoviruses: Molecular Genetics and Pathogenesis
Easton et al.
Clin. Microbiol. Rev. 2004;17:390-412.
ABSTRACT | FULL TEXT  

The natural history of respiratory syncytial virus infection in cancer and transplant patients: implications for management
Anaissie et al.
Blood 2004;103:1611-1617.
ABSTRACT | FULL TEXT  

Diagnosis and Testing in Bronchiolitis: A Systematic Review
Bordley et al.
Arch Pediatr Adolesc Med 2004;158:119-126.
ABSTRACT | FULL TEXT  

Pharmacologic Treatment of Bronchiolitis in Infants and Children: A Systematic Review
King et al.
Arch Pediatr Adolesc Med 2004;158:127-137.
ABSTRACT | FULL TEXT  

Altered Pathogenesis of Severe Pneumovirus Infection in Response to Combined Antiviral and Specific Immunomodulatory Agents
Bonville et al.
J. Virol. 2002;77:1237-1244.
ABSTRACT | FULL TEXT  

Relationship between respiratory syncytial virus bronchiolitis and future obstructive airway diseases
Wennergren and Kristjansson
Eur Respir J 2001;18:1044-1058.
ABSTRACT | FULL TEXT  

Uncertainty in the Management of Viral Lower Respiratory Tract Disease
Meissner
Pediatrics 2001;108:1000-1003.
FULL TEXT  

Effect of RSV Bronchiolitis Practice Guidelines on Resource Utilization
Harrison et al.
CLIN PEDIATR 2001;40:489-495.
ABSTRACT  

Treatment and Prevention of RSV Bronchiolitis
Dominguez
Journal of Pharmacy Practice 2001;14:166-180.
ABSTRACT  

New treatments for viral respiratory tract infections--opportunities and problems
Snell
J Antimicrob Chemother 2001;47:251-259.
FULL TEXT  

Exogenous Surfactant Supplementation in Infants with Respiratory Syncytial Virus Bronchiolitis
TIBBY et al.
Am. J. Respir. Crit. Care Med. 2000;162:1251-1256.
ABSTRACT | FULL TEXT  

Respiratory Syncytial Virus Infection: Immune Response, Immunopathogenesis, and Treatment
Domachowske and Rosenberg
Clin. Microbiol. Rev. 1999;12:298-309.
ABSTRACT | FULL TEXT  

Randomised controlled trial of budesonide for the prevention of post-bronchiolitis wheezing
Fox et al.
Arch. Dis. Child. 1999;80:343-347.
ABSTRACT | FULL TEXT  

Reducing the Morbidity of Lower Respiratory Tract Infections Caused by Respiratory Syncytial Virus: Still No Answer
Russell et al.
Pediatrics 1997;99:472-472.
FULL TEXT  

RIBAVIRIN NOT EFFECTIVE FOR INFANT RSV INFECTION
JWatch General 1996;1996:5-5.
FULL TEXT