Ribavirin

Ribavirin, a nucleoside analog, was widely chosen as an empirical therapy for SARS because of its broad-spectrum antiviral activity against many DNA and RNA viruses. It was commonly used with corticosteroids and has since become the most frequently administered antiviral agent for SARS (Peiris et al 2003a, 2003b; So et al 2003; Tsang KW et al 2003; Poutanen et al 2003; Chan-Yeung & Yu 2003; Koren et al 2003; Lee et al 2003; Booth et al 2003; Tsang & Lam 2003; Chan et al 2003; Tsui et al 2003; Ho JC et al 2003).

The use of ribavirin has attracted a lot of criticism due to its unproven efficacy and undue side effects (Cyranoski 2003). Ribavirin at nontoxic concentrations has no direct in vitro activity against SARS-CoV (Huggins 2003; Cinatl et al 2003a; Health Canada July 2, 2003). Clinical experience so far, including quantitative reverse transcriptase polymerase chain reaction (RT-PCR) monitoring the nasopharyngeal viral load, has also not been able to suggest any substantial in vivo antiviral effect from this drug (Peiris et al 2003b). It is still a moot point as to whether or not the immunomodulatory actions of ribavirin, as found in other conditions (Ning et al 1998; Hultgren et al 1998), could also play a role in the treatment of SARS (Peiris et al 2003b; Lau & So 2003).

The prevalence of side effects from ribavirin is dose-related. High doses often result in more adverse effects, such as hemolytic anemia,