In June, the Food and Drug Administration (FDA) approved the use of palivizumab (Synagis, MedImmune Inc.) an intramuscularly administered monoclonal antibody preparation directed against the F glycoprotein of RSV. The guidelines were drafted by the AAP Committee on Infectious Diseases and the Committee on Fetus and the Newborn.
Choosing which product to use will depend on age, availability of intravenous access, cost and other factors. However, the AAP guidelines also state that RSV-IGIV provides additional protection against other respiratory viral illness and may be preferred for selected high-risk children including those receiving replacement intravenous immune globulin because of underlying immune deficiency.
Physicians should also consider administering RSV-IGIV for the first month of prophylaxis to premature infants who are about to leave the hospital during RSV season. Palivizumab is not recommended - and RSV-IGIV is contraindicated - for use in children with cyanotic congenital heart disease.
There is no peer-reviewed data available on the cost-benefit analysis for palivizumab, and only a limited amount of data available for RSV-IGIV. However, the cost-benefit analyses of RSV-IGIV did not demonstrate an overall savings in hospitalization considering the costs of therapy for all at-risk children.
|AAP Recommendations on the Use of Palivizumab|
For your information:
- AAP Committee on Infectious Diseases and Committee on Fetus and Newborn. Prevention of respiratory syncytial virus infections: indications for the use of palivizumab and update on the use of RSV-IVIG. Pediatrics 1998;5:1211-1216.