Effect Of Ganciclovir In Young Children Hospitalized With Rotavirus Enteritis And Monitoring Of Rotavirus Excretion

Objective Rotavirus,a double-stranded RNA virus, is a major cause of severe gastroenteritis affecting young children worldwide. Each year, rotavirus causes approximately 2 million hospitalization and approximately 440,000 deaths in children. The first licensed vaccine was voluntarily withdrawn from the market on 1999, because of a significantly increased relative risk of intussusception after the first dose of the vaccine. The prevention to rotavirus disease has met with an obstruction. It's urgent to seek new therapeutic approaches for rotavirus enteritis in order to reduce the mortality. Rotavirus infection is thought to be localized to the gastrointestinal tract .Dehydration with electrolyte imbalance and acidosis is believed to be the cause of death in young children with rotavirus disease, so the major management is rehydration therapy by oral or intravenous administration. Several recent reports suggest that rotavirus can escape the intestinal into the circulatory system, and then causes the infection of extra-intestinal organs. Furthermore, rotavirus antigen has been detected at several extra-intestinal sites from some children who died of rotavirus disease, viremic maybe another cause of rotavirus-associated death. Children with severe rotavirus infection, who discharge rotavirus from stool during a long period after clinical cure, are the main sources of infection. Therefore, it's necessary to treat rotavirus disease with anti-rotavirus drugs. Ganciclovir is a kind of nucleoside compounds and has anextended antiviral activity, especially to DNA virus. Ganciclovir is safe and effective to treat infants with cytomegalovirus disease. A newly study indicates that ganciclovir has inhibiting function to some RNA virus too. But it's not clearly about the efficacy of ganciclovir to rotavirus. A recent report indicates that the intravenous administration of ganciclovir is an effective measure to treat rotavirus enteritis in children. In order to prove the effect of ganciclovir to rotavirus, a randomized, controlled trial and the longitudinal change of rotavirus excretion in stools were conducted from Oct. 2002 to Dec. 2003 at Zhengzhou Children's Hospital.Methods According to age (6m~2y) and typical clinical symptoms in combination with etiologic evidence of rotavirus, 96 patients within 2 days after onset were selected as study subjects. These young children were randomly assigned to two groups according to the hospitalized order. The treated group received intravenous administration of ganciclovir 5~10mg/kg/d once daily for 3 days while the control group didn't receive any antivirus drugs. But other treatments were same. Stool cultured, blood gas analysis, electrolyte and tumor necrosis factor alpha (TNF) were detected in all children before therapy. Rotavirus testing by ELISA on stool samples was performed for every patient on admission and the third day after treatment. Stool sample was collected to a clear box every day in patients with positive results until the reaction was negative. Statistic analysis was done using t test , x2 test and multiple regression analysis of Logistic.The date was dealt with SPSS 11.0 statistical software.Results 20 cases were rejected from the study and 76 patients were selected from 96 cases at last. There were 34 cases in the treated group and 42 in the controlled group. There were no significant differences between the two groups in age, sex, weight, clinical symptoms and some laboratory signs(p>0.05). The total effective rate after treatment was 88.1% and 83.1% in the treated group and the controlled group, respectively. There was no significant difference (p>0.05) between these two groups. There were no significant difference in the scores of symptoms after treatment, too (p>0.05). The duration of fever, vomiting anddiarrhea of patients in the treated group was shorter than that in the controlled group, but there were no significant differences between them (p>0.05). The negative rates of rotavirus in stool samples on the third day after treatment were 33.1% and 1...