Therapy for respiratory tract infections caused by respiratory syncytial virus.
Respiratory syncytial virus (RSV) is the most common viral cause of lower respiratory tract infection (LRTI) in infancy and young children. No effective treatment for RSV lower respiratory tract infection (RSV-LRTI) exists. Ribavirin initially proved to be an effective anti-viral drug for RSV-LTRI. However, subsequently performed trials could not reproduce these positive results and, based on the current available evidence, there is no place for ribavirin in the routine treatment of RSV-LTRI. The use of nebulised bronchodilator therapy in RSV-LTRI has been subject of many trials, with conflicting results. Although the individual patient may have some short-term benefit from nebulised bronchodilators, there does not seem to be a sufficient scientific basis for the standard use of bronchodilator therapy in infants and children with RSV-LTRI. There is increasing evidence that RSV-LTRI is an immune-mediated disease and therefore corticosteroids may be an effective treatment. The results from efficacy trials have demonstrated that corticosteroids are not effective for patients with mild RSV infection. In contrast there are indications that it may be beneficial in patients with more severe RSV-LTRI. It has been demonstrated that in children with RSV infection the vitamin A concentration is inversely related to disease severity. The use of vitamin A in the treatment of patients with RSV-LTRI, however, proved not to be effective. Immunoprophylaxis with hyperimmune immunoglobulins and monoclonal antibody against the viral F-protein have been shown to be effective in the prevention of RSV-LRTI. From the results of the therapeutic efficacy trials, however, it can be discerned that immunoglobulins have no place in the treatment of RSV-LRTI.


CONCLUSIONS
Although respiratory syncytial virus infections each year have a considerable socioeconomic impact, attempts to find an effective therapy have so far been quite unsuccessful. Anti-viral therapy with ribavirin has not been proven to be effective. Symptomatic therapy with bronchodilators may give only short-term relief of symptoms in some individual patients, but has no effect on hospitalisation rates, or duration of hospitalisation. The beneficial effect of corticosteroids in patients with mild respiratory syncytial virus infection is very disappointing, however, there are indications that there might be an effect in patients with more severe infection. So far no beneficial therapeutic effect has been demonstrated with immune globulins.
van Woensel
J
J
Paediatric Intensive Care Unit/G8ZW, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands. j.b.vanwoensel@amc.uva.nl
Kimpen
J
J
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002648:Child; D006801:Humans; D007116:Immunization, Passive; D015201:Meta-Analysis as Topic; D018357:Respiratory Syncytial Virus Infections / Q000188:drug therapy*; D012254:Ribavirin / Q000627:therapeutic use
D000305:Adrenal Cortex Hormones; D000998:Antiviral Agents; D001993:Bronchodilator Agents; D012254:Ribavirin