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Seth M. Pransky, MD; Anthony E. Magit, MD; Donald B. Kearns, MD; D. Richard Kang, MD; Newton O. Duncan, MD

Arch Otolaryngol Head Neck Surg. 1999;125:1143-1148.

Objective  To assess the potential benefit of intralesional administration of cidofovir, an acyclic nucleoside phosphonate with activity against several DNA viruses, for treating severe respiratory papillomas in pediatric patients.

Design  Prospective case series.

Setting  Tertiary care children's hospitals.

Patients  Five pediatric patients with severe recurrent respiratory papillomatosis requiring laryngoscopy with carbon dioxide laser therapy more frequently than once a month to maintain airway patency. Each patient underwent between 12 and 33 laryngoscopies with laser treatment prior to being injected with cidofovir.

Intervention  Microsuspension laryngoscopy with intralesional injection of cidofovir (Vistide) in conjunction with mechanical debulking and carbon dioxide laser of papillomas.

Main Outcome Measure  Papilloma stage at time of serial laryngoscopies.

Results  One patient was disease free and 3 patients demonstrated a dramatic response to adjuvant therapy with cidofovir at the 9-month follow-up visit after the last injection of cidofovir. One patient showed an improvement in papilloma stage that was possibly related to concurrent therapy with interferon.

Conclusions  Intralesional injection of cidofovir seems to be of benefit in the treatment of severe respiratory papillomatosis in pediatric patients. Larger prospective studies with longer follow-up will be required before cidofovir can be considered an accepted means of managing this difficult disease.

From Pediatric Otolaryngology, Children's Hospital and Health Center, San Diego, Calif (Drs Pransky, Magit, and Kearns); the Division of Otolaryngology, University of California, San Diego, School of Medicine (Dr Magit); the San Diego Naval Medical Center (Dr Kang); and Texas Ear, Nose & Throat Consultants, Houston (Dr Duncan).

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