Respiratory tract infections caused by respiratory syncytial virus in children. Diagnosis and treatment.
Respiratory syncytial virus (RSV) is the most common viral cause of lower respiratory tract infection in infancy and young children. No effective treatment for RSV lower respiratory tract infection (RSV-LRTI) exists. Ribavirine initially was reported to be an effective anti-viral drug for RSV-LRTI. However, subsequently performed trials could not reproduce these positive results and based on the current available evidence there is no place of ribavirin in the routine treatment of RSV-LRTI. The use of nebulised bronchodilator therapy in RSV-LRTI has been subject of many trials, with conflicting RESULTS. Although the individual patient may have some short term benefit of nebulised bronchodilators there does not seem to be a sufficient scientific base for the standard use of bronchodilator therapy in infants and children with RSV-LRTI. There is increasing evidence that RSV-LRTI 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 is some evidence suggesting that it may be beneficial in patients with more severe RSV-LRTI. Immunoprofylaxis with hyperimmune immunoglobulins and monoclonal antibody against the viral F-protein have been shown to be effective in the prevention of severe RSV-LRTI. From the results of the therapeutic efficacy trials, however, it is evident that immunoglobulins have no place in the treatment of RSV-LRTI. In conclusion, although RSV infections each year have a considerable socio-economic impact attempts to find an effective therapy have been quite unsuccessful so far.
Van Woensel
J B
JB
Emma Children s Hospital, Academic Medical Center, Amsterdam, The Netherlands. j.b.vanwoensel@amc.uva.nl
Kimpen
J L
JL
Brand
P L
PL
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D001990:Bronchiolitis, Viral / Q000175:diagnosis; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002675:Child, Preschool; D002986:Clinical Trials as Topic; D003937:Diagnosis, Differential; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use; D007223:Infant; D007231:Infant, Newborn; D015201:Meta-Analysis as Topic; D018357:Respiratory Syncytial Virus Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D012254:Ribavirin / Q000627:therapeutic use
D000305:Adrenal Cortex Hormones; D000911:Antibodies, Monoclonal; D000998:Antiviral Agents; D001993:Bronchodilator Agents; D007136:Immunoglobulins; D012254:Ribavirin