RESPIRATORY SYNCYTIAL VIRUS-INFECTIONS AN D RIBAVIRIN TREATMENT - CLINICAL AND ECONOMIC-EVALUATION

The controversy about the use of ribavirin aerosol for children at ris k (cardiopathy, pneumopathy, premature and immunodeficient patients), in case of respiratory syncytial virus (RSV) infection, led us to stop its prescription in 1993 and study prospectively the patients admitte d during the following winters. Methods. - Criterias of inclusion for this study were those of the Committee on Infectious Diseases of the A merican Academy of Pediatrics concerning the rise of ribavirin aerosol . Two cohorts of patients were studied: the first group included treat ed patients (ribavirin group: n = 22, ribavarin and support treatment: salbutamol aerosols, respiratory physiotherapy and oxygen-therapy; wi nters 1989-1990 to 1992-1993); the second group included patients with support treatment only (control group: n = 22; winters 1993-1994 and 1994-1995). Results. - The clinical gravity score at admission (4.55 v s 5.23, P = 0.461 and the risk factor scores (3.05 vs 3.27, P = 0.69) of the two groups were identical. Results showed that the children of the ribavirin group stayed much longer in hospital (14.2 vs 8.2 days, P = 0.0021 and in the intensive care unit (7.2 vs 0.2 days, P < 0.0011 than those of the control group. More support treatment was necessary for the ribavirin group as regard respiratory physiotherapy (3.8 vs 2 .7 sessions a day, P = 0.026), the duration of oxygen-therapy (7.3 vs 3.7 days, P = 0.030) and the number of children requiring respiratory assistance (4 vs 0 children, P = 0.116). Administration of ribavinin a erosols (480 US$; a dose) and the way in which such treatment was carr ied out meant high daily costs for the ribavirin group (1,076 vs 604 U S$, P < 0.001). As hospitalization was longer for children treated wit h ribavirin, the global cost was therefore much higher (15,552 vs 5, 1 56 US$, P < 0.001). Conclusion. - The antiviral effect of ribavirin is undeniable. However ribavirin is known to be the cause of severe bron chospasms (two cases in our study) and can also cause moderate and lon g term bronchospasms, aggravating therefore the clinical evolution of the disease. Our experience shows that adminisitration of ribavirin ae rosols in case of RSV infection of inferior respiratory airways seems nor to be justified. (C) 1998 Elsevier, Paris.