Ribavirin (Tribavirin) is a synthetic nucleoside which may be administered by inhalation via a special ventilator for RSV bronchiolitis in infants and children. Efficacy for this indication is controversial, and it is usually reserved for the most severe cases, and those with co-existing illnesses, such as immunosuppression. Systemic absorption by the inhalational route is negligible. It is effective by mouth (tV2 45 h) in treating Lassa fever and, when combined with interferon alfa-2b, for chronic hepatitis C infection (see below). Systemic ribavirin is an important teratogen, and it may cause cardiac, haematological, gastrointestinal and neurological side effects.
Palivizumab may be given by monthly i.m. injection in the winter and early spring to infants at high risk of suffering RSV infection. Transient fever and local injection site reactions are seen, and rarely gastrointestinal disturbance, rash, leucopenia or disturbed liver function may occur.
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