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

From the Guidelines

Treatment for RSV infection is primarily supportive care, focusing on managing symptoms and supporting the body's immune response, as there is no specific antiviral medication approved for routine use. The main recommendations for supportive care include:

• Rest and hydration: Ensure adequate fluid intake to prevent dehydration.
• Nasal suctioning: Use saline drops and a bulb syringe to clear nasal passages, especially in infants.
• Fever control: Use acetaminophen or ibuprofen as needed for fever or discomfort.
• Humidified air: Use a cool-mist humidifier to ease breathing and reduce congestion.
• Monitoring: Watch for signs of respiratory distress or dehydration. In severe cases, hospitalization may be necessary for:

• Supplemental oxygen
• Intravenous fluids
• Mechanical ventilation (in rare, severe cases) For high-risk infants, palivizumab (Synagis) may be given as a preventive measure during RSV season, administered monthly as an intramuscular injection at 15 mg/kg 1. This is particularly recommended for infants born at 32 weeks of gestation or earlier, or those with certain underlying health conditions such as congenital heart disease or chronic lung disease 1. It's essential to note that palivizumab is not a treatment for RSV infection but rather a preventive measure to reduce the risk of hospitalization due to RSV infection in high-risk infants. The use of ribavirin, an antiviral medication, is not recommended for routine use in children with bronchiolitis due to its marginal benefit and potential risks 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) infection is ribavirin (IV), 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.
• The decision to treat with VIRAZOLE should be based on the severity of the RSV infection.

From the Research

Treatment for Respiratory Syncytial Virus (RSV) Infection

The treatment for RSV infection is primarily supportive, with the following measures:

• Feeding support and oxygen supplementation until the infant's immune system mounts a response capable of controlling the disease 3
• Supplemental oxygen therapy, ventilation, and fluid and nutrition therapy 4
• Management strategies may include targeting not only high-risk populations, but also previously healthy children who represent the majority of children hospitalized with RSV infection 5

Antiviral Therapy and Immunoprophylaxis

• Ribavirin is the only licensed drug for the specific treatment of RSV infection, but it has not been recommended for routine clinical use due to drug toxicity and minimal clinical benefit 3
• Palivizumab, a monoclonal antibody, reduces the risk of hospitalization due to RSV infection by 39-78% in various high-risk infants predisposed to developing severe RSV disease 3, 4
• Novel therapeutic options, including nanobodies, polyclonal and monoclonal antibodies, have emerged and are in preclinical and Phase-I, -II or -III clinical trials 5
• RSV immune globulin intravenous therapy has been evaluated, but its efficacy in the treatment of children at high risk for severe RSV infection is not significant 6

Emerging Therapies and Prevention Strategies

• The advent of molecular point-of-care testing allows rapid and accurate confirmation of RSV infection and could reduce antibiotic use 7
• RSV is now a vaccine-preventable disease in young children with a market-approved long-acting monoclonal antibody and a maternal vaccine targeting the RSV prefusion protein 7
• Implementation of RSV preventive strategies will clarify the full burden of RSV infection, and vaccine probe studies can address existing knowledge gaps 7