Ribavirin Therapy of Respiratory Syncytial Virus

Abstract
Ribavirin is an antiviral drug that has recently been approved by the FDA in an aerosolized form for the therapy of respiratory syncytial virus infections in hospitalized children who do not require assisted ventilation. Ribavirin is different from other antiviral drugs both in its spectrum of activity and in its mode of administration.1,2 The following statement is presented to identify which children should be considered for ribavirin therapy. Questions also have arisen as to the benefits afforded by treatment in comparison to the potential unknown toxicity of the drug and as to whether ribavirin should be administered to infants who require assisted ventilation; the package insert has warned against using the drug in such patients. Whether pregnant women or personnel who care for infants being treated with ribavirin are at risk from exposure to the drug is also of concern. Finally, physicians must be aware that the cost of ribavirin needed for three days of therapy is almost $700. BACKGROUND Respiratory Syncytial Virus Disease Respiratory syncytial virus is the most important cause of lower respiratory tract disease in infants and young children. It usually appears in yearly winter to spring outbreaks and infects essentially all children during their first 3 years of life. The number of infected infants who require hospitalization has been estimated to range in different locations from one in 50 to one in 1,000. Currently, the mortality in hospitalized infants who were previously normal is low, less than 1%.3 In infants with underlying diseases, however, the mortality may be strikingly higher.3-5