Efficacy of oral ribavirin in lung transplant patients with respiratory syncytial virus lower respiratory tract infection.
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.
Pelaez
Andres
A
Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia 30322, USA. apelaez@emory.edu
Lyon
G Marshall
GM
Force
Seth D
SD
Ramirez
Allan M
AM
Neujahr
David C
DC
Foster
Marianne
M
Naik
Priyumvada M
PM
Gal
Anthony A
AA
Mitchell
Patrick O
PO
Lawrence
E Clinton
EC
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
D000305:Adrenal Cortex Hormones; D000998:Antiviral Agents; D012254:Ribavirin; D008776:Methylprednisolone Hemisuccinate