Systemic Ribavirin Therapy for Respiratory Syncytial Virus Infections in Pediatric Solid Organ Transplant Patients: A single hospital experience over 3 RSV seasons
Background: Respiratory Syncytial Virus (RSV) is the most common cause of lower respiratory tract infection in children and supportive care remains the mainstay of therapy. Immunocompromised patients are more severely affected by RSV infection, but approved treatment options remain limited. Systemic Ribavirin treatment for RSV infections has been previously described in lung transplant recipients, but its use in in pediatric solid organ transplant (SOT) patients has not been well defined. Given the large volume of pediatric SOT patients at our center, we retrospectively analyzed the use of systemic ribavirin for RSV infections in this patient population.
Methods: We reviewed medical records for all pediatric transplant patients who had positive RSV antigen and/or PCR testing from October 2011 to April 2014. Patient characteristics, use and dosage of Ribavirin from pharmacy records, immunosuppresive therapy, co-infections, clinical and laboratory changes were evaluated.
Results: Fifteen patients who were RSV positive received eighteen courses of Ribavirin; one patient also received IV Ribavirin for compassionate. Eight patients who were RSV positive were not treated. Patient transplant types and demographics are provided in Figures 1 and 2. The oral Ribavirin dose ranged from 15-20mg/kg/day, given for a range of 5-14 day courses. Treatment had to be stopped in one patient due to pancytopenia. Additional outcome measures for PICU admission, oxygen requirement, need for mechanical ventilation showed no significant difference between the two groups. One patient in each group received Palivizumab for RSV prophylaxis per consensus guidelines.
Conclusion: This is the first larger study of systemic ribavirin use for RSV in pediatric SOT patients.
Ribavirin was well tolerated in our pediatric SOT transplant patients with RSV infection without severe side effects. There were missed opportunities to provide RSV prophylaxis for these high risk patients. Larger prospective studies are needed to better describe oral Ribavirin as a potential treatment for RSV in this patient population.
K. Khan, None