Pre-emptive use of aerosolized ribavirin in the treatment of asymptomatic pediatric marrow transplant patients testing positive for RSV

Respiratory syncytial virus is a common virus which frequently causes sever e lower tract disease in immunocompromised patients. The mortality rate in bone marrow transplant patients with lower tract disease varies from 31% to 100%, depending upon the treatment used, time before initiation of treatme nt, and whether patients are pre- or post-engraftment, Therapy with inhaled ribavirin has been used with limited success in decreasing mortality rate, Because of concern about conversion from upper respiratory tract disease t o lower respiratory tract disease, we conducted a pilot study using aerosol ized ribavirin in asymptomatic RSV-positive patients, Patients had NP washe s performed on a weekly basis during the RSV season, for the presence of RS V, If patients were positive, but asymptomatic, and could have their transp lant postponed, they were treated with ribavirin until negative, Patients w ho could not be postponed received aerosolized ribavirin, and began transpl ant conditioning. During this study, we performed 145 nasal aspirations for RSV on 25 patients; 10 aspirates were positive in seven asymptomatic patie nts. All positive events were successfully treated with ribavirin, which cl eared the RSV for a minimum of 3 weeks. No patients became symptomatic. Thu s, we conclude that ribavirin can clear asymptomatic infections in immunoco mpromised pediatric transplant patients.