A randomized, double-blind, placebo-controlled trial of dexamethasone in severe respiratory syncytial virus (RSV) infection: effects on RSV quantity and clinical outcome

Abstract

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; n5 22) or saline placebo (n5 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 246 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 dexa-methasone group from day 0 to day 1 (0.82 vs. 0.21 log pfu/mL; P5.01) and from day 0 to day 2 (1.45 vs. 0.53 log pfu/mL; P5.03). No differences were found between groups in nasal RSV quantity, white blood cell counts in tracheal or nasal aspirates, serum neutralizing antibody titers during con-valescence, or duration of mechanical ventilation, intensive care unit stay, or hospital stay. Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infection in infants. Published data indicate that RSV infection results in the hospitalization of 73,400–126,300 infants annually in the United States [1]. At present, therapeutic options for the management of RSV lower respiratory tract ill