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Efficacy of Oral Ribavirin in Lung Transplant Patients With Respiratory Syncytial Virus Lower Respiratory Tract Infection
- Publication Year :
- 2009
-
Abstract
- Background Respiratory syncytial virus (RSV) can cause severe lower respiratory tract infection (LRI) and is a risk factor for the development of bronchiolitis obliterans syndrome (BOS) after lung transplantation (LTx). Currently, the most widely used therapy for RSV is inhaled ribavirin. However, this therapy is costly and cumbersome. We investigated the utility of using oral ribavirin for the treatment of RSV infection after LTx. Methods RSV was identified in nasopharyngeal swabs (NPS) or bronchoalveolar lavage (BAL) using direct fluorescent antibody (DFA) in 5 symptomatic LTx patients diagnosed with LRI. Data were collected from December 2005 and August 2007 and included: age; gender; type of LTx; underlying disease; date of RSV; pulmonary function prior to, during and up to 565 days post-RSV infection; need for mechanical ventilation; concurrent infections; and radiographic features. Patients received oral ribavirin for 10 days with solumedrol (10 to 15 mg/kg/day intravenously) for 3 days, until repeat NPS were negative. Results Five patients had their RSV–LRI diagnosis made at a median of 300 days post-LTx. Mean forced expiratory volume in 1 second (FEV 1 ) fell 21% ( p 1 returned to baseline and was maintained at follow-up of 565 days. There were no complications and no deaths with oral therapy. A 10-day course of oral ribavirin cost $700 compared with $14,000 for nebulized ribavirin at 6 g/day. Conclusions Treatment of RSV after LTx with oral ribavirin and corticosteroids is well tolerated, effective and less costly than inhaled ribavirin. Further studies are needed to directly compare the long-term efficacy of oral vs nebulized therapy for RSV.
- Subjects :
- Male
Time Factors
viruses
medicine.medical_treatment
Administration, Oral
Gastroenterology
Pulmonary function testing
chemistry.chemical_compound
Pulmonary Disease, Chronic Obstructive
Postoperative Complications
Adrenal Cortex Hormones
Forced Expiratory Volume
Methylprednisolone Hemisuccinate
Infusions, Intravenous
medicine.diagnostic_test
virus diseases
respiratory system
Middle Aged
Respiratory Syncytial Viruses
Chemoprophylaxis
Female
Cardiology and Cardiovascular Medicine
Bronchoalveolar Lavage Fluid
Lung Transplantation
Pulmonary and Respiratory Medicine
Adult
medicine.medical_specialty
Sarcoidosis
Bronchiolitis obliterans
Respiratory Syncytial Virus Infections
Antiviral Agents
Article
Internal medicine
Lower respiratory tract infection
Ribavirin
medicine
Lung transplantation
Humans
Aged
Transplantation
business.industry
medicine.disease
Bronchoalveolar lavage
chemistry
Bronchiolitis
Immunology
Surgery
business
Follow-Up Studies
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....f40a034df2cc2e6cc38021e9bc35be22