The Exposure of Health Care Workers to Ribavirin Aerosol-Reply

In Reply.—  Dr Harkness states that our recommendations would eliminate the use of ribavirin early in the course of respiratory syncytial virus infection "when clinical benefit would be expected." Marks and colleagues claim that there is a "growing database that suggests that this drug is safe and effective for children at high risk from complications due to respiratory syncytial virus." The University of California at San Francisco task force, as well as other clinicians,¹ came to a different conclusion, namely, that the clinical efficacy of aerosolized ribavirin is not established.The teratogenicity, mutagenicity, and embryolethal effects of ribavirin have not been observed in any primate species. Marks et al reviewed the manufacturer's data regarding the use of aerosolized ribavirin in more than 22 000 infants and noted an adverse drug reaction rate of less than 0.2%. While the retrospective analysis of Marks et al suggests that the drug is