title: Oral Ribavirin for the Treatment of Noninfluenza Respiratory Viral Infections: A Systematic Review.
abstract: OBJECTIVE
  To review clinical outcomes data for patients treated with oral ribavirin for noninfluenza respiratory viral infections (NIRVIs).
  
  
  METHODS
  MEDLINE, EMBASE, and PubMed Central (1972 to June 1, 2015) were queried with the following search term combinations: "Oral" AND "ribavirin" AND ("respiratory syncytial virus" OR "metapneumovirus" OR "parainfluenza" OR "coronavirus" OR "rhinovirus" OR "enterovirus" OR "adenovirus").
  
  
  METHODS
  Included studies must have characterized the clinical outcomes of a cohort of patients treated with oral ribavirin for symptomatic NIRVIs. Case reports and series with <5 cases, conference abstracts, and articles written in languages other than English were excluded.
  
  
  RESULTS
  Of the 1256 unique reports, 15 met inclusion criteria: 12 retrospective, 3 prospective, and 3 comparative with untreated control groups. All studies except for 2 Middle East respiratory syndrome coronavirus (MERS-CoV) studies were in immunocompromised patients (9 malignancy/stem cell transplant, 4 lung transplant). The mortality rate ranged from 0% to 31% in malignancy/stem cell transplant recipients treated with oral ribavirin, and 1/108 (0.9%) ribavirin-treated lung transplant recipients died at 30 days. Three studies (one each for malignancy, lung transplant, and MERS-CoV) suggested a clinical outcomes benefit with oral ribavirin compared with supportive care alone; however, the nonrandomized design precludes efficacy determination. Hemolysis was the most common adverse reaction, occurring in 14% (54/375) of patients. Ribavirin was discontinued in 4% of patients secondary to adverse reactions.
  
  
  CONCLUSIONS
  Oral ribavirin should be considered for the treatment of NIRVI in immunocompromised adults (malignancy/stem cell transplant or lung transplant) or adults with MERS-CoV.
authors.affiliation: University of Illinois at Chicago, College of Pharmacy, Chicago, IL, USA University of Illinois Hospital and Health Sciences System, Chicago, IL, USA aegross@uic.edu.
authors.forename: Alan E
authors.initials: AE
authors.lastname: Gross
authors.affiliation: University of Illinois at Chicago, College of Pharmacy, Chicago, IL, USA Drug Information Group, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Bryson
mesh_terms: D000284:Administration, Oral; D000998:Antiviral Agents / Q000627:therapeutic use*; D004267:DNA Viruses; D006801:Humans; D016867:Immunocompromised Host; D012328:RNA Viruses; D012141:Respiratory Tract Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D012254:Ribavirin / Q000627:therapeutic use*; D014777:Virus Diseases / Q000188:drug therapy* / Q000276:immunology / Q000821:virology
chemical_list: D000998:Antiviral Agents; D012254:Ribavirin
keywords: antivirals; community-acquired pneumonia; infectious diseases; respiratory infections; viral infections