A Randomized, Double-Blind, Placebo-Controlled Trial of Dexamethasone in Severe Respiratory Syncytial Virus (RSV) Infection: Effects on RSV Quantity and Clinical Outcome

• Published in: The Journal of infectious diseases Vol. 185; no. 9; pp. 1222 - 1228
• Main Authors: Buckingham, Steven C., Jafri, Hasan S., Bush, Andrew J., Carubelli, Cecilia M., Sheeran, Paul, Hardy, R. Doug, Ottolini, Martin G., Ramilo, Octavio, DeVincenzo, John P.
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University of Chicago Press 01-05-2002; University of Chicago Press
• Subjects: Antibodies, Viral - blood; Biological and medical sciences; Bronchiolitis; Corticosteroids; Dexamethasone - therapeutic use; Double-Blind Method; Female; Gestational age; Human respiratory syncytial virus; Human viral diseases; Humans; Infant; Infant, Newborn; Infants; Infectious diseases; Intensive care units; Length of Stay; Leukocyte Count; Major Articles; Male; Medical sciences; Nose - immunology; Nose - virology; Pediatrics; Placebos; Respiratory syncytial virus infections; Respiratory Syncytial Virus Infections - drug therapy; Respiratory Syncytial Virus Infections - virology; Respiratory syncytial viruses; Respiratory Syncytial Viruses - isolation & purification; Trachea - immunology; Trachea - virology; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Viral diseases of the respiratory system and ent viral diseases; Viral Load; Human; Corticosteroid; Dexamethasone; Antibody; Steroid hormone; Vision disorder; Modeling; Blood; Infection; Virus; Eye disease; Blood cell; Viral disease; Blindness; Serum; Severe; Child; Blood cell count; Age
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1086/340024

Forty-one previously healthy children <2 years of age who required mechanical ventilation for respiratory syncytial virus (RSV) infection were randomized to receive dexamethasone (0.5 mg/kg; n = 22) or saline placebo (n = 19) intravenously every 12 h for 4 days. RSV quantity was measured by quantitative plaque assay in fresh tracheal and nasal aspirates obtained at intervals of 24 ± 3 h on days 0, 1, 2, 5, and 7 following entry. Analysis by linear mixed-effects modeling demonstrated a significantly greater decline in mean tracheal RSV quantity in the placebo group than in the dexamethasone group from day 0 to day 1 (0.82 vs. 0.21 log pfu/mL; P = .01) and from day 0 to day 2 (1.45 vs. 0.53 log pfu/mL; P = .03). No differences were found between groups in nasal RSV quantity, white blood cell counts in tracheal or nasal aspirates, serum neutralizing antibody titers during convalescence, or duration of mechanical ventilation, intensive care unit stay, or hospital stay.