AEROSOLIZED IMMUNOGLOBULIN TREATMENT OF RESPIRATORY SYNCYTIAL VIRUS-INFECTION IN INFANTS

Background, Recent studies in animals with experimental respiratory sy ncytial virus (RSV) infection indicate that passive immunization by in tranasal or intratracheal application of gamma-globulins (immunoglobul ins) may be beneficial for treatment of infants with lower respiratory tract infection caused by RSV. Methods, We conducted a placebo-contro lled, randomized multicenter study involving 68 infants with proven RS V infection admitted to 5 pediatric centers in Switzerland from Novemb er 1, 1992, through April 30, 1993, Treatment was carried out with aer osolized human IgG (Sandoglobulin(R)) by assisted ventilation, On the day of hospital admission a single dose of 0.1 g of IgG per kg of body weight in a 5% solution or an identical amount of placebo, each deliv ered in 2 parts, was given. Results. The two groups did not differ sub stantially in their response to the aerosol received, The rate of impr ovement for symptoms of respiratory tract infection, oxygen requiremen t and length of hospital stay were comparable for both groups. There w as a significant reduction (P < 0.05) in the frequency of apneic spell s observed in the treatment group by Day 3 posttreatment, Aerosol ther apy was generally well-tolerated in nonintubated infants, but some sev ere side effects (increased oxygen requirements in two patients, pneum othorax in one patient) were observed in two of three intubated and ve ntilated infants treated with IgG. Conclusions, Aerosolized immunoglob ulin in the dosage used had no substantial beneficial effect on RSV br onchiolitis, Despite these findings passive immunotherapy for treatmen t of RSV-induced lower respiratory tract infection deserves further ev aluation before being discarded as ineffective.