HIGH-DOSE, SHORT-DURATION RIBAVIRIN AEROSOL THERAPY COMPARED WITH STANDARD RIBAVIRIN THERAPY IN CHILDREN WITH SUSPECTED RESPIRATORY SYNCYTIAL VIRUS-INFECTION

Children with suspected respiratory syncytial virus infection were exa mined prospectively in a randomized evaluation of standard ribavirin a erosol therapy (6 gm/300 ml water for 18 hours daily) compared with hi gh-dose, short-duration ribavirin aerosol therapy (6 gm/100 ml water g iven for a period of 2 hours three times a day) by means of an oxygen hood (n = 20) or a ventilator (n = 12). Viral shedding was quantitated daily; clinical observations were recorded daily by 2 physicians awar e and one unaware of treatment assignments. Study characteristics eval uated at entry were not significantly different in the high-dose and t he standard-dose groups. Viral titers and clinical scores decreased si milarly in both groups during the study; pulmonary function test resul ts were also similar at discharge in children not receiving mechanical ventilation. Potential complications related to aerosol therapy were noted in three patients (one hood patient who was receiving standard t herapy; two patients with an endotracheal tube in place who were recei ving high-dose therapy); substantial crystallization was noted in the tubing of the patients undergoing intubation and receiving high-dose t herapy. Environmental sampling revealed that ribavirin was nearly unde tectable near patients supported by mechanical ventilation who were re ceiving either form of therapy, and was significantly decreased on a d aily basis in patients without an endotracheal tube who were receiving high-dose therapy compared with those receiving standard therapy. The effects of high-dose, short-duration aerosol ribavirin therapy were s imilar to those of standard-dose therapy in our study patients and res ulted in a decreased release of ribavirin into the room of patients re ceiving therapy by means of an oxygen hood.