Palivizumab for Treatment Rather Than Prophylaxis of RSV Bronchiolitis :

The criteria for which infants need to receive palivizumab, the monoclonal antibody used for respiratory syncytial virus (RSV) prophylaxis, has been well-defined by the Committee on Infectious Diseases (COID) of the American Academy of Pediatrics (AAP). While some might argue with the criteria, COID used the highest quality evidence available to create these guidelines. What the guidelines do not address is whether palivizumab would be helpful for the acute treatment of RSV.  Fortunately, Alansari et al. (10.1542/peds.2018-2308) address this question in a double-blind randomized trial being released this month in our journal.  The authors looked at over 400 infants under 3 months of age presenting to the emergency department with RSV-positive bronchiolitis requiring admission. These infants were then randomized to receive 15 mg/kg of palivizumab or placebo.  The results showed no significant difference in readiness for discharge or readmission between the palivizumab and control groups.  Although palivizumab can help in preventing disease, once infected, this drug does not appear to help.  If you need more convincing, be in the nose (or we mean in the know) and read this study so your use of palivizumab remains limited as a prophylactic agent for those babies that qualify to receive it.