title: Efficacy of oral ribavirin in lung transplant patients with respiratory syncytial virus lower respiratory tract infection.
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 < 0.012) during infection. After treatment, FEV(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.
authors.affiliation: Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia 30322, USA. apelaez@emory.edu
authors.forename: Andres
authors.initials: A
authors.lastname: Pelaez
authors.forename: G Marshall
authors.initials: GM
authors.lastname: Lyon
authors.forename: Seth D
authors.initials: SD
authors.lastname: Force
authors.forename: Allan M
authors.initials: AM
authors.lastname: Ramirez
authors.forename: David C
authors.initials: DC
authors.lastname: Neujahr
authors.forename: Marianne
authors.initials: M
authors.lastname: Foster
authors.forename: Priyumvada M
authors.initials: PM
authors.lastname: Naik
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Gal
authors.forename: Patrick O
authors.initials: PO
authors.lastname: Mitchell
authors.forename: E Clinton
authors.initials: EC
authors.lastname: Lawrence
mesh_terms: D000284:Administration, Oral; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001992:Bronchoalveolar Lavage Fluid; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006801:Humans; D007262:Infusions, Intravenous; D016040:Lung Transplantation / Q000009:adverse effects* / Q000502:physiology; D008297:Male; D008776:Methylprednisolone Hemisuccinate / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy / Q000821:virology*; D029424:Pulmonary Disease, Chronic Obstructive / Q000601:surgery; D018357:Respiratory Syncytial Virus Infections / Q000188:drug therapy*; D012136:Respiratory Syncytial Viruses; D012254:Ribavirin / Q000008:administration & dosage / Q000627:therapeutic use*; D012507:Sarcoidosis / Q000601:surgery; D013997:Time Factors
chemical_list: D000305:Adrenal Cortex Hormones; D000998:Antiviral Agents; D012254:Ribavirin; D008776:Methylprednisolone Hemisuccinate