What is the treatment for Respiratory Syncytial Virus (RSV)?

From the Guidelines

Treatment for RSV primarily involves supportive care to manage symptoms and prevent complications, with no specific antiviral medication routinely used for RSV. Key treatment recommendations include:

• Rest and hydration: Ensure plenty of fluids and rest to support the immune system.
• Nasal suctioning: Use saline drops and a bulb syringe to clear nasal passages, especially in infants.
• Humidified air: Use a cool-mist humidifier to ease breathing and reduce congestion.
• Acetaminophen or ibuprofen: For fever and pain relief, follow age-appropriate dosing guidelines.
• Bronchodilators: In some cases, albuterol may be prescribed to help with wheezing, though effectiveness varies.
• Oxygen therapy: For severe cases with low oxygen levels, supplemental oxygen may be necessary.
• Monitoring: Watch for signs of worsening symptoms or difficulty breathing. These treatments aim to alleviate symptoms and support the body's natural healing process. RSV is typically self-limiting, and most cases resolve within 1-2 weeks. However, in high-risk groups (premature infants, elderly, immunocompromised), close medical supervision may be required to prevent complications like pneumonia or respiratory failure, as noted in studies such as 1 and 1. For high-risk infants, palivizumab prophylaxis may be considered, as recommended by the American Academy of Pediatrics, to reduce the risk of hospitalization due to RSV infection, as discussed in 1. It's also important to note that ribavirin, an antiviral agent, is not recommended for routine use in treating RSV infection, except in selected patients with potentially life-threatening infections, as stated in 1 and 1.

From the FDA Drug Label

VIRAZOLE® (Ribavirin for Inhalation Solution, USP) is indicated for the treatment of hospitalized infants and young children with severe lower respiratory tract infections due to RSV. Treatment early in the course of severe lower respiratory tract infection may be necessary to achieve efficacy. Only severe RSV lower respiratory tract infection should be treated with VIRAZOLE

The treatment for Respiratory Syncytial Virus (RSV) is ribavirin (INH), specifically VIRAZOLE (Ribavirin for Inhalation Solution, USP), for hospitalized infants and young children with severe lower respiratory tract infections due to RSV 2.

• Treatment should be initiated early in the course of severe lower respiratory tract infection to achieve efficacy.
• Severe RSV lower respiratory tract infection should be documented by a rapid diagnostic method before or during the first 24 hours of treatment.
• Treatment may be initiated while awaiting rapid diagnostic test results, but should not be continued without documentation of RSV infection.

From the Research

Treatment Options for Respiratory Syncytial Virus (RSV)

• The primary treatment for RSV is supportive care, which includes oxygen therapy, hydration, and nutrition 3, 4, 5.
• Aerosolized ribavirin is licensed for RSV treatment, but its use is limited due to issues with efficacy, safety, and cost 3.
• Palivizumab, an RSV monoclonal antibody, is licensed for the prevention of RSV disease in high-risk pediatric populations and has demonstrated effectiveness in reducing hospitalization rates 3, 6, 4, 7.
• Immunoglobulin treatment has not shown significant benefit in treating RSV infection 6.
• New antiviral treatments, vaccines, and long-acting monoclonal antibodies are in development, but it may be several years before they are licensed and available for use 3, 7.

Supportive Care Measures

• Maintaining oxygen saturation above 90% 5.
• Providing hydration and nutrition through nasogastric or intravenous routes if needed 5.
• Avoiding therapies such as bronchodilators, epinephrine, nebulized hypertonic saline, corticosteroids, antibiotics, and chest physiotherapy, as they are not recommended for RSV bronchiolitis treatment 5.

Prevention Strategies

• Palivizumab prophylaxis for high-risk infants and children 3, 4, 7.
• New preventative strategies, including vaccines and long-acting monoclonal antibodies, are in development and show promise 7.
• Nirsevimab, a monoclonal antibody with an extended half-life, has recently been registered in the European Union and granted licensure by the US Food and Drug Administration 7.
• A pre-fusion sub-unit protein vaccine has been granted licensure for pregnant women to protect their young infants 7.