Ribavirin for Respiratory Syncytial Virus Lower Respiratory Tract Infection

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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