Inhaled ribavirin has been shown to be effective in treatment of non-influenza respiratory tract infections, yet use is limited by its tetratogenicity and inconvenience of administration. There has been paucity of data for oral and intravenous ribavirin in non-influenza respiratory tract infections. This study seeks to evaluate the efficacy and safety outcomes of ribavirin use in viral respiratory tract infections in the Singapore population.
This was a single-centre, retrospective study. All patients who have received at least 1 dose of ribavirin between 1st January 2011 and 31st March 2013 were identified from the hospital pharmacy database and included. Relevant information was obtained from patient medical records and results analyzed qualitatively. Subgroup analysis of combination ribavirin and IVIG therapy versus ribavirin monotherapy efficacy in treatment outcomes were analyzed with Chi-square test.
Ninety patients were treated with ribavirin for viral respiratory tract infections, with a median age of 55 (16-89) years. Up to 77.0% of patients had leukemia/lymphoma; 14 patients had a history of bone marrow or renal transplant. Majority were treated for respiratory syncytial virus (48.9%) and parainfluenza virus infections (28.9%). Ten patients (11.1%) were treated for metapneumovirus infections. Ribavirin was prescribed for a median duration of 6 (1 – 28) days; 25 patients (27.5%) prescribed concurrent IVIG. Eighty-eight patients (97.8%) were prescribed oral ribavirin. There was no difference in clinical improvement and 30-day mortality between ribavirin and IVIG combination therapy versus monotherapy (p>0.05).
Twelve patients (15.4%) did not have dose reduction of ribavirin for renal impairment, with 5 developing adverse drug reactions. Overall, 19 patients (21.1%) had elevated liver enzymes and 11 (12.2%) had hematologic abnormalities. At the end of ribavirin therapy, 22 patients had viral eradication and clinical improvement (24.4%). Despite clinical improvement, 4 patients had 14-day reinfection. Thirty-day mortality rate was 12.2% (11/90 patients), with cause contributed to pneumonia in 9 patients.
Ribavirin use did not show much utility in the treatment of viral respiratory tract infections, with poor clinical outcomes and high incidence of adverse events.
C. L. L. Lim,
A. L. Kwa, None