This randomized, double-blind, placebo-controlled phase 2 trial will be conducted at a single tertiary pediatric intensive care unit (PICU). The study will include children with RSV infection who were admitted to the pediatric intensive care unit and require respiratory support via positive pressure ventilation (invasive and noninvasive).
Eligible participants include all children admitted to the PICU at Children's of Alabama with a diagnosis of RSV infection and requiring positive pressure ventilation, invasive or noninvasive, including bilevel positive airway pressure (BiPAP) or high flow nasal cannula (HFNC) oxygen (ie, \>1 L/kg/min of flow, with 5 L/min flow for children weighing \<5 kg). During hospitalization, all patients will be treated according to the American Academy of Pediatrics guidelines for the management of bronchiolitis, primarily supportive care. Participants will then be randomized according to a permuted-block design to receive either placebo (saline) or AZM (Fresenius Kabi) at 10mg/kg/d (ie, standard dose) or 20mg/kg/d (ie, high dose) intravenously every 24 hours for 3 days. All biologic samples collected will be analyzed in the PI's lab at the University of Alabama at Birmingham. Drug pharmacokinetics will be performed at the Pharmaceutical Sciences Research Institute of Samford University, Birmingham, AL.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
48
UAB
Birmingham, Alabama, United States
Number of Participants With Treatment-related Adverse Events as Assessed by CTCAE v4.0
To determine the safety profile of AZM at 10 mg/kg and 20 mg/kg IV X 3 days in children with RSV-induced respiratory failure
Time frame: Baseline through Day 3
Nasal Total Matrix Metalloproteinase (MMP)-9 Level
To determine the concentration of total MMP-9 levels in the nasal compartment
Time frame: Day 3
Pharmacokinetic-Plasma Half Life of AZM
Measurement of AZM half life in the plasma
Time frame: From baseline to 72 hours post treatment
Pharmacokinetic-Lung Half Life of AZM
Measurement of AZM half life in the lung
Time frame: From baseline to 72 hours post treatment
Duration of Mechanical Ventilation in Days
Duration of mechanical ventilation in days for enrolled subjects
Time frame: Pre-treatment through 2 weeks
Duration of BiPAP in Days
Duration of BiPAP in days for enrolled subjects
Time frame: Pre-treatment through 2 weeks
Duration of High Flow Nasal Cannula in Days
Duration of High Flow Nasal Cannula in days for enrolled subjects
Time frame: Pre-treatment through 2 weeks
Duration of Oxygenation in Days
Duration of oxygenation in days for enrolled subjects
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Time frame: Pre-treatment through 2 weeks
Duration of Hospitalization in Days
Duration of hospitalization in days for enrolled subjects
Time frame: Pre-treatment through 2 weeks
Duration of PICU Stay in Days
Duration of PICU stay in days for enrolled subjects
Time frame: Pre-treatment through 2 weeks