Sección de Hematología pediátrica, Servicio de Hematología, Department of Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)/CSIC/Universidad de Sevilla, Sevilla, Spain.
Bone Marrow Transplant. 2013 Feb;48(2):265-8. doi: 10.1038/bmt.2012.134. Epub 2012 Sep 24.
Respiratory syncytial virus (RSV) is a potential cause of serious morbidity and even mortality among children undergoing hematopoietic SCT (HSCT). Contrary to the available information regarding the aerosolized formulation of ribavirin, there is a paucity of published studies using i.v. ribavirin in adults, and very few single reports on pediatric patients. Aerosolized drug administration has been limited by potential toxicity and special air-flow requirements. In this regard, i.v. ribavirin could prevent these disadvantages, but its efficacy and safety remain controversial in the pediatric HSCT setting. The present study describes the outcome of six pediatric patients undergoing HSCT with nine episodes of proven RSV. Four episodes corresponded to lower respiratory tract infection (LRTI) and five presented with upper respiratory tract infection (URTI). All LRTI patients showed favorable clinical responses, with 100% survival and no progression to LRTI in the remaining five URTI. No side effects were documented during ribavirin administration. We conclude that ribavirin was well tolerated intravenously, without associated side effects, and was effective in the treatment of RSV in this limited number of pediatric HSCT patients. The role and efficacy of i.v. ribavirin needs to be further clarified by prospective controlled trials in pediatric populations.
呼吸道合胞病毒（RSV）是造血干细胞移植（HSCT）儿童发生严重发病率甚至死亡率的潜在原因。与利巴韦林雾化制剂的现有信息相反，静脉内利巴韦林在成人中的应用研究很少，儿科患者的单一报告也很少。雾化药物给药受到潜在毒性和特殊气流要求的限制。在这方面，静脉内利巴韦林可以预防这些缺点，但在儿科 HSCT 环境中的疗效和安全性仍存在争议。本研究描述了 6 例接受 HSCT 的儿科患者的结果，共发生 9 例经证实的 RSV 感染。4 例为下呼吸道感染（LRTI），5 例为上呼吸道感染（URTI）。所有 LRTI 患者均表现出良好的临床反应，存活率为 100%，其余 5 例 URTI 患者未进展为 LRTI。利巴韦林给药期间未记录到副作用。我们得出结论，利巴韦林静脉内给药耐受性良好，无相关副作用，对这有限数量的儿科 HSCT 患者的 RSV 治疗有效。静脉内利巴韦林的作用和疗效需要通过儿科人群的前瞻性对照试验进一步阐明。
