A Cochrane review [Abstract] 1 [withdrawn from The Cochrane Library Issue 5, 2010] included 12 trials among infants below the age of six months . Mortality with ribavirin was 5.8% compared with 9.7% with placebo (OR 0.58, 95% CI 0.18 to 1.85; 4 trials, n=158). The probability of respiratory deterioration was 7.1% with ribavirin compared with 18.3% with placebo (OR 0.37; 95% CI 0.12 to 1.18; 3 trials, n=116). Days of hospitalization and days of ventilation were fewer with ribavirin (WMD -1.9, 95% CI -4.6 to +0.9, and -1.8, 95% CI -3.4 to -0.2, respectively; 3 trials, n=104). No statistically significant differences in long-term pulmonary function or in incidence of recurrent wheezing following RSV infection were associated with the use of ribavirin.
Another systematic review 2 including 8 RCTs with a total of 269 subjects was abstracted in DARE. The relative risk for overall mortality was 0.6 (95% CI 0.22 to 1.75). The relative risk for respiratory deterioration (3 studies) was 0.4 (95% CI 0.16 to 1.13). Two studies showed a significant reduction in length of ventilation while the third did not. Days of oxygen dependence were also significantly shorter in the treated group in two of these studies. The days of hospitalisation favoured ribavirin with an weighted mean difference of -2.48 days (95% CI -7.29 to 2.97). The 5 studies with clinical improvement as the main outcome measure showed a significant improvement with ribavirin (standardised effect size 1.44, 95% CI 1.08 to 1.79).
Comment: The quality of evidence is downgraded by imprecise results (few patients and wide confidence intervals) and by indirectness of evidence (the effect of ribavirin on clinically important outcomes such as mortality and respiratory deterioration needs to be proven to justify its use).
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