Intravenous palivizumab and ribavirin combination for respiratory syncytial virus disease in high-risk pediatric patients

Background: Risk factors for severe respiratory syncytial virus (RSV) disease include prematurity, congenital heart disease, chronic lung disease, and immunocompromised states. There is no consensus concerning the most effective therapy for severe RSV infection in high-risk patients. Palivizumab is approved for prevention of RSV disease, and ribavirin is approved for treatment of RSV infections but its efficacy in high-risk patients has not been conclusively established. Methods: Retrospective chart review of RSV infected children treated with intravenous palivizumab and ribavirin in a pediatric hospital from 2001 to 2005. Results: Twenty male and 11 female patients with a median age of 23.4 months, hospitalized for RSV infection were treated with intravenous palivizumab from October 2001 through July 2005. Mean dose was 14.93 (SD = 0.68) mg/kg. Twenty-five patients (80%) also received ribavirin, 22 of whom by aerosolization. Common baseline diagnoses were malignancy (n = 15), congenital heart disease (n = 5), and prematurity (n = 5). Included above are 1 cardiac and 6 hematopoietic stem cell transplant recipients. Eighteen (58%) patients had signs of lower respiratory tract infection, 17 were hypoxemic, 10 required intensive care unit (ICU) admission, and 5 were intubated. Twenty-nine (93.6%) patients survived and 2 died. No adverse events attributed to intravenous palivizumab or ribavirin administration were observed. Conclusions: Treatment of RSV-infected high-risk children with intravenous palivizumab alone or in combination with ribavirin was well tolerated and associated with decreased mortality compared with previous reports.