Lassa fever medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Yazan Daaboul, M.D.; Serge Korjian M.D.; Ammu Susheela, M.D. [2]
Overview
Intravenous (IV) ribavirin is the antiviral drug of choice for the treatment of Lassa fever. Ribavirin is administered intravenously for a total of 10 days using the following regimen: first, loading dose of 30 mg/kg (max. 2g) followed by a dose of 16 mg/kg (max. 1g) IV q6h for 4 days, followed by a dose of 8 mg/kg (max. 500mg) IV q8h for 6 days. In addition to antiviral therapy, management includes supportive care to adequately maintain respiratory status, as well as fluid and electrolyte balance.
Medical Therapy
- All hospitalized individuals with suspected Lassa fever should be isolated with proper disposal of body fluids and excreta.
- Supportive care, including adequate fluid and electrolyte replacement and blood transfusions, may also be required.
- Intravenous (IV) ribavirin is the antiviral drug of choice for the treatment of Lassa fever.
- Ribavirin is more effective when administered early in the course of the disease than when administered late.[1]
- Compared with oral ribavirin, intravenous (IV) ribavirin is almost twice as effective.[2]
| Optimal Treatment |
Ribavarin[3]
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Pregnancy
- For 3rd-term pregnant women with Lassa fever, the risk of death is very high (odds ratio for death 5.57). Among these patients, emergent evacuation of the uterus (by induction or surgically) has been demonstrated to decrease the risk of death.[4] It is hypothesized that evacuating the uterus decreases the viral load significantly as the virus has high affinity for the placenta and other highly vascular tissues. Observational studies have demonstrated that the fetus has only a one in ten chance of survival irrespective of the therapies used or the interventions attempted. For that reason, the main focus is on reducing the risk of death in the mother. Following active obstetrical intervention, treatment with ribavirin should be initiated immediately.
References
- ↑ Fact sheet N°179: Lassa Fever. World Health Organization. Accessed on June 09, 2015.
- ↑ Fisher-Hoch SP, McCormick JB (2004). "Lassa fever vaccine". Expert review of vaccines. 3 (2): 189–97. doi:10.1586/14760584.3.4.S189. PMID 15056044.
- ↑ Borio L, Inglesby T, Peters CJ, Schmaljohn AL, Hughes JM, Jahrling PB; et al. (2002). "Hemorrhagic fever viruses as biological weapons: medical and public health management". JAMA. 287 (18): 2391–405. PMID 11988060.
- ↑ Price ME, Fisher-Hoch SP, Craven RB, McCormick JB (1988). "A prospective study of maternal and fetal outcome in acute Lassa fever infection during pregnancy". BMJ. 297 (6648): 584–7. PMID 3139220.