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Antimicrobial Agents and Chemotherapy, December 2004, p. 4631-4635, Vol. 48, No. 12
0066-4804/04/$08.00+0 DOI: 10.1128/AAC.48.12.4631-4635.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.
Pharmacokinetics and Effects of Ribavirin following Intraventricular Administration for Treatment of Subacute Sclerosing Panencephalitis
Mitsuaki Hosoya,1* Shuichi Mori,2 Akemi Tomoda,3 Kenji Mori,4 Yukio Sawaishi,5 Hiroshi Kimura,6 Shiro Shigeta,2 and Hitoshi Suzuki1Department of Pediatrics,1 Department of Microbiology, Fukushima Medical University School of Medicine, Fukushima,2 Department of Child Development, Kumamoto University School of Medicine, Kumamoto,3 Department of Pediatrics, Tokushima University School of Medicine, Tokushima,4 Department of Pediatrics, Akita University School of Medicine, Akita,5 Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan6
Received 30 January 2004/ Returned for modification 23 June 2004/ Accepted 5 August 2004
Ribavirin is a broad-spectrum antiviral drug with inhibitory activity against many RNA viruses, including measles virus. Five patients with subacute sclerosing panencephalitis (SSPE) were treated with ribavirin by intraventricular administration. Although there were transient side effects attributed to ribavirin, such as drowsiness, headache, lip and gingival swelling, and conjunctival hyperemia, intraventricular ribavirin therapy was generally safe and well tolerated. The cerebrospinal fluid (CSF) ribavirin concentration decreased, as described by a monoexponential function, after a single intraventricular dose. There was considerable interindividual variability, however, in the peak level and half-life. We aimed to adjust the individual dose and frequency of intraventricular administration based on the peak level and half-life of ribavirin in the CSF in order to maintain the CSF ribavirin concentration at the target level. Clinical effectiveness (significant neurologic improvement and/or a significant decrease in titers of hemagglutination inhibition antibodies against measles virus in CSF) was observed for four of five patients. For these four patients, CSF ribavirin concentrations were maintained at a level at which SSPE virus replication was almost completely inhibited in vitro and in vivo, whereas the concentration was lower in the patient without clinical improvement. These results suggest that intraventricular administration of ribavirin is effective against SSPE if the CSF ribavirin concentration is maintained at a high level. Intraventricular ribavirin therapy should be pursued further for its potential use for patients with SSPE and might be applied in the treatment of patients with encephalitis caused by other RNA viruses.
* Corresponding author. Mailing address: Department of Pediatrics, Fukushima Medical University School of Medicine, Hikarigaoka-1, Fukushima 960-1295, Japan. Phone: (81) 24-547-1111. Fax: (81) 24-548-6578. E-mail: mhosoya{at}fmu.ac.jp.
Antimicrobial Agents and Chemotherapy, December 2004, p. 4631-4635, Vol. 48, No. 12
0066-4804/04/$08.00+0 DOI: 10.1128/AAC.48.12.4631-4635.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.
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