Abstract
Introduction: RSV bronchiolitis results in the hospitalisation of thousands of infants each year. Treatment is predominantly supportive, but palivizumab (humanised monoclonal anti-RSV antibody) administration can provide passive protection.Objectives: To analyse experimental literature to determine whether palivizumab administration is warranted and safe in high-risk infants hospitalised with bronchiolitis. The outcomes assessed included viral titres, duration of hospitalisation, hospitalisation rates, and prospective incidence of recurrent wheezing.Methods: Cochrane library- searched with terms “Palivizumab” and “bronchiolitis”;PubMed- searched with MeSH terms “Palivizumab” and “bronchiolitis”.Results: Palivizumab prophylaxis resulted in significant reduction in hospitalisation rates (1%) compared to in non-prophylaxed seasons (13.5%), and the numbers needed to treat to avoid one hospitalisation was 13 (95% CI: 4-8).Prospective observation studies, suggested that prophylactic administration of palivizumab effectively reduced admissions to hospital due to re-infection.Incidence of recurrent wheezing and physiciandiagnosed recurrent wheezing was significantly lower in antibody-treated subjects (13% and 8% respectively) compared with untreated subjects (26%, P=0.01 and 16%, P=0.011 respectively).Injection site reactions were uncommon (1.8% in the placebo group compared to 2.7% in the palivizumab group). Mild or moderate elevations of ALT occurred in 1.6% of placebo and 3.6% of palivizumab recipients.Conclusion: Palivizumab use is warranted in preterm infants hospitalised with bronchiolitis. The primary demonstrated benefit is a reduction in hospital admission rates. Further work is necessary to determine the safety of palivizumab, and the efficacy in high-risk infants (e.g. those with bronchopulmonary dysplasia). The cost-effectiveness of palivizumab administration in a UK health care setting must be assessed.
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