Intravenous Ribavirin Protocol to Treat Individuals With Viral Hemorrhagic Fever

Exclusion Criteria

• •• Has known intolerance to ribavirin.
• •* Is irreversibly ill on presentation, as defined by presence of profound shock (shock which does not respond to supportive therapy within 3 hours after admission).
• •* Has hemoglobin less than 10 g/dL that cannot be corrected to 10 g/dL before initiation of IV ribavirin
• •* Has history of hemoglobinopathies (ie, sickle-cell anemia or thalassemia major).
• •* Has history of autoimmune hepatitis.
• •* Has serum calculated creatinine clearance of \< 30 mL/min.
• •* History of second or third degree heart block or sick sinus syndrome without a pacemaker and no capability of a pacemaker placement or Wolfe-Parkinson-White Syndrome.
• •* A sinus bradycardia of less than 40 beats per minute (see below).
• •* Is currently being treated with didanosine (ddI). ddI must be discontinued before starting IV ribavirin.
• •A positive pregnancy test. The patient will be informed of the risk and benefit of treatment with IV ribavirin versus no ribavirin treatment for CCHF (generally associated with high mortality) and severe cases of Lassa fever (high mortality rates) versus mild cases of Lassa fever (low mortality rates).
• •A New York Heart Association cardiac functional capacity of Class II or greater for atherosclerotic heart disease (ASHD) and congestive heart failure (CHF).
• •Known cardiac defects that may predispose the subject to bradyarrhythmias, such as second or third degree heart block or sick sinus syndrome without a pacemaker, but capability of pacemaker placement, if needed.
• •Sinus bradycardia of 41-49 beats per minutes, if the individual is not known to have a low resting heart rate related to physical conditioning.
• •Use of drugs known to result in bradyarrhythmias (certain beta blockers and calcium channel blockers, digoxin, as well as clonidine, cholinesterase inhibitors, and lithium).
• •History of gout