Respiratory syncytial virus, treatment

Severe lower respiratory tract infections - Treatment of hospitalized infants and young children with severe lower respiratory tract infections caused by respiratory syncytial virus (RSV). 

The drugs described next are used in the treatment in a variety of viral conditions, including HBV, hepatitis C virus (HCV), respiratory syncytial virus (RSV), human papilloma virus (HPV), and VZV. Some are also used in the therapy of HIV infection detailed information on the treatment of this disease is found in Chapter 51. 

Ribavirin Virazole Treatment of severe viral pneumonia caused by respiratory syncytial virus in infants and young children... 

Antiviral Efficacy and Clinical Use. Ribavirin (Vira-zole) is active against several RNA and DNA viruses, including respiratory syncytial virus (RSV).106 Clinically, this drug is used to treat severe RSV pneumonia in infants and young children,106 and RSV in certain adult populations, including the elderly, people with cardiopulmonary problems, and people with a compromised immune system.29 Ribavirin may also be useful as a secondary agent in the treatment of influenza A and B in young adults. The combination of ribavirin and interferons (see section on Interferons, later) is often the treatment of choice in chronic hepatitis C infection.30 72... 

Viral respiratory tract infections for which treatments exist include those of influenza types A and B, and respiratory syncytial virus (RSV). [Note Immunization against influenza A is the preferred approach. However, antiviral agents are employed when patients are allergic to the vaccine or when the outbreak is due to an immunologic variant of the virus not covered by vaccines, or when outbreaks occur among unvaccinated individuals at risk who are in closed settings, for example, in a nursing home.]... 

Rodriguez WJ, Bui RH, Connor JD, Kim HW, Brandt CD, Parrott RH, Burch B, Mace J. Environmental exposure of primary care personnel to ribavirin aerosol when supervising treatment of infants with respiratory syncytial virus infections. Antimicrob Agents Chemother 1987 31(7) 1143-6. 

Ribavirin is well absorbed orally, bnt it can be given in aerosol form for the treatment of respiratory syncytial virus (RSV) infections in immunocompromised patients, and in those with cardiopulmonary abnormalities, or in infants receiving mechanical ventilation (8,9). 

TNFa is classically associated with septic shock and diverse infectious pathological conditions. It is involved in the development of a protective immune response in tuberculosis. Measurable serum TNFa levels have been detected in 10.5% of children with pulmonary tuberculosis, all of whom belonged to the group with active disease. Results suggest a protective role for TNFa in respiratory syncytial virus infection. In patients with chronic hepatitis C during treatment with IFNa, elevated production of TNFa by PBMCs may be due to host response to the virus. In HIV infection, TNFs and IL-6 stimulate viral replication. 

Ribavirin is a virustatic agent approved for administration as an aerosol for the treatment of lower respiratory tract infections caused by respiratory syncytial virus [93,94]. However, its therapeutic efficacy in this disease has come into question of late [95]. A newer group of antiviral agents have been developed that... 

Therapeutics—prevention of respiratory syncytial virus (RSV) infection, treatments of inflammation, breast cancer, non-Hodgkin s lymphoma, and treatment or prevention of transplant rejection... 

Respiratory syncytial virus is the most common cause of acute bronchiolitis, an infection that mostly affects infants during their first year of life. In the well infant, bronchiolitis is usually a self-limiting viral illness, whereas in the child with underlying respiratory or cardiac disease or both, the child may develop severe respiratory compromise (failure) necessitating in-hospital treatment, such as rehydration, oxygen, and in select patients, bronchodilators, ribavirin aerosol, or both. 

Ottolini MG, Hemming VG. Prevention and treatment recommendations for respiratory syncytial virus infection. Drugs 1997 54 867-884. 

The influenza virus is an RNA-(—)- virus and possesses its own RNA polymerase enzyme. The complete RNA genome codes for eight proteins - two structural (matrix) proteins M, and M2, haemagglutinin, and neuraminidase and four proteins involved in replication, three of which make up the polymerase enzyme. Substrates for this are the usual ribonucleosides and there has been some success with the use of nucleoside analogues as inhibitors of the enzyme. The drug ribavirin has been the most successful, although this has to be administered by aerosol. These days, its major use is for the treatment of infections caused by respiratory syncytial viruses (especially in children), since these can cause long-term morbidity. 

Simoes EAF (1997) Respiratory syncytial virus infection pathogenesis, treatment and prevention. Curr Opin Infect Dis 10 213-220... 

Bond S, Sanford VA, Lambert IN et al (2005) Preparation of polycyclic agents for the treatment of respiratory syncytial virus infections. World Patent Application W02005/ 061513 Al... 

Ribavirin is a synthetic guanosine analogue, with in vitro activity against a broad spectrum of DNA and RNA viruses, and retroviruses, including HIV. Ribavirin has been used for treatment of a variety of viral infections, including respiratory syncytial virus bronchiolitis and pneumonia, measles, influenza types A and B, Lassa fever, hemorrhagic fever with renal syndrome (Hantaviruses), hepatitis C, and HIV infection. It is used commonly now along with interferon alpha for treatment of hepatitis C infection. There is no known direct nephrotoxicity of ribavirin. 

In the United States ribavirin has been approved (1987) only for the treatment of respiratory syncytial virus (RSV) in children, while the drug is marketed in over 20 countries for many other viral diseases. Clinical potentials of ribavirin are being evaluated against influenza, measles, AIDS, dengue, and lassa fever. 

Ribavirin is indicated in the treatment of carefully selected hospitalized infants and young children with severe lower respiratory tract infections due to respiratory syncytial virus (RSV). In addition, ribavirin (600 to 1800 mg/day for 10 to 14 days) has shown effectiveness in acute and chronic hepatitis, herpes genitalis, measles, and Lassa fever. 

Clinical use and toxicity Ribavirin is used in aerosol form for respiratory syncytial virus infections. Early intravenous administration decreases mortality in Lassa fever and other viral hemorrhagic fevers. Ribavirin has recently been shown to have efficacy in treatment of hepatitis C viral infections. Aerosol ribavirin may cause conjunctival or bronchial irritation. Systemic use results in dose-dependent myelosuppression. Ribavirin is a known human teratogen. absolutely contraindicated in pregnancy. 

The antiviral actions of this drug include inhibition of both RNA and DNA synthesis. The drug is used for the treatment of severe respiratory syncytial virus infections in neonates. 

Respiratory syncytial virus (RSV) causes bronchiolitis in children, usually during the winter months. Most RSV infections clear without treatment. Ribavirin is recommended for infected children who are at risk for cardiopulmonary complications. The utility of such treatment has not been clearly demonstrated. 

The first effective and safe treatments for Alzheimer s, Parkinson s, chronic graft rejection, permanent graft acceptance, obesity, chronic obstructive pulmonary disease (COPD), adult respiratory distress syndrome (ARDS), sepsis, and vaccines [common cold, respiratory syncytial virus (RSV), severe acute respiratory syndrome (SARS), AIDS, malaria. Avian Influenza, radiation, contraception, emerging new infections] will be multibillion-dollar products [15,16]. 

Respiratory syncytial virus (RSV) and parainfluenza virus (PIV) are leading causes of respiratory disease in infants, young children, immuno-compromized patients, and the elderly. Bitko et al. [140] used viral-specific siRNAs for the treatment of these respiratory syndromes in an animal model. In this study, either, or both, viral infections could be specifically prevented and inhibited when corresponding siRNAs were infused intranasally in mice, with or without transfection reagents. These investigators noted an excellent correlation between the activities observed in their siRNAs in in vitro cell cultures and those observed in their animal model. This type of approach presents a fast screen for efficient siRNA sequences before more expensive and demanding applications are pursued in animals. In addition, nasal administration of siRNA compounds seems to provide a convenient... 

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