A randomised double blind placebo controlled trial of treatment with an aerosolised antiviral agent, ribavirin, was conducted in 26 infants with clinically diagnosed bronchiolitis. Nebulised ribavirin (14 infants) or normal saline aerosol (12 infants) was given for 18 hours a day for at least three days. Respiratory syncytial virus was identified in nasal secretions from 20 cases (10 from both groups). Trends in seven out of eight clinical variables favoured active treatment. Ribavirin aerosol was associated with significantly faster improvement in cough and crepitations and more rapid rate of fall in respiratory and heart rates. In the 20 infants from whose nasal secretions respiratory syncytial virus was identified most variables favoured treatment with ribavirin, with significant reduction in chest recession. 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. The study suggests nebulised ribavirin may have a place in the treatment of some cases of bronchiolitis.
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