Ribavirin Ribavirin is a nucleoside analog with good in vitro activity against RSV. Ribavirin is approved by the United States Food and Drug Administration (FDA) for the treatment of RSV infection.
In children The routine use of nebulized ribavirin in infants and children with RSV LRTI is not recommended. The efficacy of ribavirin in this population has not been clearly proven [16,17]. In addition, ribavirin is expensive and must be given early in the course to be effective, and there are concerns regarding occupational exposure [16]. (See 'Adverse effects' below.)
Randomized controlled trials comparing ribavirin with placebo in children with RSV LRTI have yielded mixed results. Some studies have demonstrated decreased severity of illness, decreased duration of mechanical ventilation, oxygen therapy and hospital stay, and decreased viral shedding [18-21], whereas other studies have not demonstrated these benefits [22-24]. A systematic review of randomized trials comparing ribavirin with placebo in infants and children with RSV infection and LRTI found that trials of ribavirin lack sufficient power to provide reliable estimates of the effects [16].
The American Academy of Pediatrics recommends against the routine use of ribavirin [25]. Ribavirin should be reserved for immunosuppressed patients with severe RSV infection. Consultation with an expert in infectious diseases is recommended before its use.
In adults Although the routine use of ribavirin is not recommended for infants and children with RSV LRTI, ribavirin may be beneficial for certain adults. Early use of inhaled ribavirin has been shown to reduce morbidity and mortality in adult bone marrow transplant recipients who develop RSV infections [26]. The efficacy of ribavirin for patients with solid-organ transplants is unknown [27,28].
Contraindications Ribavirin is considered to be contraindicated in pregnant women, and a negative pregnancy test should precede its use in women of child-bearing age. Ribavirin is a known teratogen in rodent species. However, it has not been shown to be teratogenic in primates, and no adverse effects have been found in the human fetus.
Adverse effects Adverse effects related to occupational exposure to ribavirin have not been reported. However, the National Institute of Occupational Safety and Health has published recommendations to reduce the ambient air concentrations of ribavirin and limit occupational exposure to hospital personnel [29].
