A Placebo Controlled Trial of Ribavirin Aerosol in The Treatment of Acute Bronchiolitis

Abstract

A randomized double-blind study, comparing treatment with an aerosolized antiviral agent, Ribavirin, 20mg/ml saline, and aerosolized saline has been conducted in 26 infants (14 Ribavirin, 12 Placebo) with clinically diagnosed bronchiolitis. Nebulized Ribavirin or normal saline aerosol was given for 18 hours a day for at least 3 days. Identification of Respiratory Syncitial virus was made in nasal secretions from 20 cases (10 Ribavirin, 10 Placebo). Treatment was delivered for an average of 68 hours in the Ribavirin group and 65 in the Placebo group. Three times daily clinical assessment was made of the infants. Trends in 13 out of 14 clinical indices recorded favoured active treatment. Ribavirin aerosol was associated with significantly faster improvement and reduction in cough, crepitations, and respiratory rate (P<.05). In the 20 infants from whose nasal secretions RSV was identified most trends favoured Ribavirin treatment with reduction in chest recession reaching statistical significance (P<.05). No difference was found in the rate of clearance of respiratory syncytial virus. The treatment was well tolerated as judged clinically and from the results of haematological and biochemical studies. These observations suggest nebulized Ribavirin may have a place in the treatment of some cases of bronchiolitis.