From the Guidelines
Treatment for Respiratory Syncytial Virus (RSV) infection is primarily supportive care, as there is no specific antiviral medication approved for routine use in most cases. Supportive measures include ensuring adequate hydration through oral fluids or, if necessary, intravenous fluids; managing fever with acetaminophen (10-15 mg/kg every 4-6 hours) or ibuprofen (5-10 mg/kg every 6-8 hours) for children over 6 months; nasal suctioning to clear secretions; and using a cool-mist humidifier to ease congestion. For severe cases requiring hospitalization, supplemental oxygen may be provided to maintain oxygen saturation above 90%. In high-risk infants and children with severe disease, the antiviral medication ribavirin may occasionally be used, though its routine use is not recommended due to limited efficacy, high cost, and potential toxicity. For prevention in high-risk infants (premature babies, those with chronic lung disease or congenital heart disease), nirsevimab, a long-acting monoclonal antibody, is recommended for all infants aged <8 months who are born during or entering their first RSV season and for infants and children aged 8–19 months who are at increased risk for severe RSV disease and are entering their second RSV season, as per the latest guidance from the Advisory Committee on Immunization Practices (ACIP) in 2023 1. Most RSV infections resolve within 1-2 weeks, with the most severe symptoms typically improving within 3-5 days. RSV causes inflammation and excess mucus production in the airways, which explains why supportive care focusing on hydration, comfort, and breathing support forms the cornerstone of treatment while the immune system clears the infection. Key considerations for prevention and treatment include:
- Identifying high-risk infants and providing them with appropriate prophylaxis, such as nirsevimab, during the RSV season.
- Ensuring supportive care measures are in place to manage symptoms and prevent complications.
- Limiting the use of ribavirin to severe cases due to its limited efficacy and potential toxicity.
- Following the latest recommendations from reputable health organizations, such as the ACIP, for the prevention and treatment of RSV infection.
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 (INH), specifically VIRAZOLE (Ribavirin for Inhalation Solution, USP), for hospitalized infants and young children with severe lower respiratory tract infections due to RSV.
- Treatment should be initiated early in the course of severe lower respiratory tract infection to achieve efficacy.
- The decision to treat with VIRAZOLE should be based on the severity of the RSV infection.
- Diagnosis of RSV infection should be documented by a rapid diagnostic method before or during the first 24 hours of treatment 2.
From the Research
RSV Treatment Overview
- The treatment of Respiratory Syncytial Virus (RSV) infection primarily consists of supportive care, which may include bronchodilators and ribavirin 3, 4, 5.
- In severe cases, especially in high-risk infants, prophylaxis with palivizumab (Synagis) or RSV-immunoglobulin intravenous (RSV-IGIV) may be used to reduce the incidence of hospitalization due to RSV infection 3, 6, 7.
Supportive Care and Antiviral Treatment
- Supportive care, such as adequate nutrition and oxygen therapy, is the mainstay of treatment for RSV infection 7.
- Ribavirin, an antiviral medication, may be used in complicated cases, especially in infants with underlying conditions such as congenital heart disease or bronchopulmonary dysplasia 4, 5.
- Bronchodilators may also be used to help manage symptoms, but their effectiveness can vary 7.
Prophylaxis with Palivizumab or RSV-IGIV
- Palivizumab, a humanized monoclonal antibody, has been shown to reduce hospitalization due to RSV infection by 55% in high-risk infants 6.
- RSV-IGIV provides passive immunity against RSV infections and has been shown to decrease the incidence of RSV hospitalization by 41% to 65% 3.
- The use of palivizumab or RSV-IGIV is typically reserved for high-risk infants, such as those with prematurity or bronchopulmonary dysplasia 3, 6, 7.