EFFICACY OF ORAL RIBAVIRIN IN OUTCOME OF BRONCHIOLITIS DUE TO RESPIRATORY SYNCYTIAL VIRUS (RSV) IN CHILDREN ON CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) THERAPY

Abstract

Background: Respiratory syncytial virus (RSV) bronchiolitis is a significant cause of acute respiratory disease in young children, especially those under the need of continuous positive airway pressure (CPAP) support. The possibility of oral ribavirin in the betterment of the outcome in such a high-risk population is a clinically important issue. Aim: To assess the effectiveness of oral ribavirin to enhance clinical outcomes in children with RSV bronchiolitis who need support using CPAP. Methods: A randomized controlled trial was carried out at the Rawal Medical and Dental Hospital in Islamabad during a period of three months, from 20th December 2025 to 20th March 2026. Four hundred and sixty children aged 1-24 months with confirmed RSV bronchiolitis were recruited and randomized to a ribavirin (n=230) or control group (n=230). The ribavirin group was provided with oral ribavirin (812mg/kg/day) during 5 days and support, and control group was administered to the ribavirin were provided with routine management. The main outcome was the successful treatment, which is the discharge without complications in five days. Secondary outcomes included hospital stay, respiratory complications, need for ventilatory support, and mortality. Statistical analysis was performed with SPSS version 26 and a statistical significance of p ≤ 0.05. Results: Success of treatment was seen in 211 (91.7%) patients with ribavirin group versus 199 (86.5%) patients with the control group though the difference was not statistically significant (p = 0.072). Ribavirin was associated with significantly lower rates of retractions (13.9% vs. 26.1%, p = 0.001), cyanosis or oxygen requirement (10.4% vs. 29.6%, p < 0.001), ventilator support (7.4% vs. 13.0%, p = 0.045), and mortality (1.3% vs. 7.0%, p = 0.002). Stratified analysis demonstrated much higher treatment success among patients with age >12 months (p = 0.014) and male patients (p = 0.015). Conclusion: Oral ribavirin, in comparison with supportive care alone, did not significantly increase the primary outcome of treatment success, but was linked with significant improvements in respiratory complications, ventilatory support, and mortality. These results indicate that there may be a clinical utility of ribavirin in severe RSV bronchiolitis that is treated with CPAP in children, despite the need of additional multicenter research.