From the Guidelines
Systemic steroids are not indicated for the treatment of Respiratory Syncytial Virus (RSV) infection. The provided evidence does not directly address the use of systemic steroids in RSV infection, but it discusses their use in other viral infections such as COVID-19, SARS, and MERS, where the consensus leans towards avoiding routine use of corticosteroids due to lack of clear benefit and potential for harm 1. The pathophysiology of RSV involves inflammation, but unlike in asthma, this inflammation does not respond well to steroid therapy. In fact, some studies suggest steroids might potentially prolong viral shedding and suppress important immune responses needed to fight the infection. Treatment for RSV remains primarily supportive, focusing on adequate hydration, nasal suctioning, and oxygen supplementation when needed. For severe cases in high-risk patients, specific antiviral medications like palivizumab might be considered for prevention, but steroids should be avoided unless there is a clear alternative indication such as a concurrent asthma exacerbation.
Key points to consider:
- The use of systemic corticosteroids in viral infections like COVID-19 and SARS has been associated with potential harms, including delayed viral clearance and increased risk of secondary infections 1.
- There is no clear evidence to support the routine use of corticosteroids in RSV infection, and their use should be approached with caution.
- Supportive care measures, such as hydration, nasal suctioning, and oxygen supplementation, remain the mainstay of treatment for RSV infection.
- Specific antiviral medications, like palivizumab, may be considered for prevention in high-risk patients, but their use should be guided by current clinical guidelines and evidence.
From the Research
Systemic Steroids for RSV Infection
- The use of systemic steroids for Respiratory Syncytial Virus (RSV) infection is not generally recommended for treatment, as stated in studies 2, 3, 4.
- A study from 2011 5 found that short courses of systemic steroids in patients hospitalized with RSV infection did not affect viral load or shedding, but may mildly diminish humoral immunity.
- The American Academy of Pediatrics updated its clinical practice guideline for diagnosis and management of RSV bronchiolitis in 2014, recommending against the use of bronchodilators, epinephrine, corticosteroids, hypertonic saline, and antibiotics for treatment of RSV infection 4.
- Other studies 3, 6 also suggest that supportive and symptomatic management should be the mainstay of treatment for RSV infection, rather than the use of systemic steroids or other therapies.
Indications and Contraindications
- There is no clear indication for the use of systemic steroids in the treatment of RSV infection, except in cases where patients have underlying conditions such as COPD or asthma, as mentioned in study 5.
- The use of systemic steroids may be considered in certain cases, but the potential benefits must be balanced against potential risks, such as the mild diminishment of humoral immunity 5.
- The majority of studies 2, 3, 4, 6 recommend against the use of systemic steroids for RSV infection, citing a lack of evidence for their effectiveness and potential for adverse effects.