Severe Acute Respiratory Syndrome in Children

Lauren J. Stockman, MPH*†; Mehran S. Massoudi, PhD, MPH*; Rita Helfand, MD*; Dean Erdman, DrPH*; Alison M. Siwek, MPH*†; Larry J. Anderson, MD*; Umesh D. Parashar, MD, MPH*

Disclosures

Pediatr Infect Dis J. 2007;26(1):68-74. 

In This Article

Treatment

Current treatment is based primarily on supportive care; there is not enough information on the efficacy and safety of treatments for SARS to recommend a specific regimen. In an attempt to control inflammation and reduce viral replication, corticosteroids and ribavirin were the most commonly used therapies during the 2003 outbreak. Interferon-α, a cytokine with antiviral activity, and combination protease inhibitors (eg, ritonavir and lopinavir), also were given. However, to date, no prospective, randomized, controlled trials have been conducted to verify the efficacy of any of these treatments, and many safety issues have been raised. Toxicity such as hemolytic anemia and hepatic dysfunction has been noted in adults after treatment of SARS with ribavirin.[39,40,41,42] Corticosteroid use for SARS has raised concerns of immunosuppressive effects and delayed viral clearance,[43] as well as potential longer term complications such as osteonecrosis or avascular necrosis of bone.[23,26,27] Convalescent plasma from patients with SARS and immunoglobulin have each been used in combination with ribavirin and corticosteroids, but the added benefit of this regimen is unclear. In the pediatric setting, a combination of corticosteroids and short term use of intravenous or oral ribavirin was well-tolerated without serious adverse events such as hemolytic anemia,[12,14] but evidence of the therapeutic efficacy of either agent is lacking.[16]

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