From the Guidelines
Elderly patients with RSV infection should primarily receive supportive care, as there are no specific antiviral medications approved for RSV in adults, and consideration for RSV vaccination is recommended for those aged ≥60 years, especially with underlying risk factors, as stated in the position paper from the Portuguese Society of Pulmonology and other societies 1. The treatment approach includes:
- Adequate hydration and rest
- Acetaminophen (325-650 mg every 4-6 hours, not exceeding 3000 mg daily) or NSAIDs like ibuprofen (400-600 mg every 6-8 hours with food) for fever and pain relief
- Supplemental oxygen if oxygen saturation falls below 92%
- Bronchodilators such as albuterol (2.5 mg via nebulizer every 4-6 hours) for patients with underlying COPD or asthma to manage wheezing and bronchospasm
- Hospitalization for severe cases requiring more intensive respiratory support, including high-flow oxygen therapy or mechanical ventilation
- Antibiotics are not recommended unless there is evidence of bacterial co-infection Prevention strategies are crucial, including:
- Practicing good hand hygiene
- Avoiding close contact with infected individuals
- Considering RSV vaccination if available and recommended for their age and risk profile, as suggested by various countries' guidelines, such as the USA, which recommends a single dose of RSV vaccine in adults ≥75 years of age and in adults 60–74 years of age with increased risk of severe RSV disease 1. The elderly are particularly vulnerable to severe RSV complications due to age-related immune decline and higher prevalence of underlying conditions, making prompt medical attention essential when symptoms develop.
From the FDA Drug Label
Ribavirin for inhalation solution, USP is indicated for the treatment of hospitalized infants and young children with severe lower respiratory tract infections due to respiratory syncytial virus. The FDA drug label does not answer the question.
From the Research
Treatment for RSV in Elderly Patients
The recommended treatment for an elderly patient with Respiratory Syncytial Virus (RSV) infection is primarily supportive care, as there are few evidence-based RSV-specific treatments currently available 2.
- Supportive care is the main modality of treatment, with a focus on managing symptoms and preventing complications.
- In some cases, antiviral medications such as ribavirin may be used, particularly in immunocompromised patients or those with severe disease 3, 4.
- New diagnostics and therapeutics are being developed, which will need rigorous evaluation to ensure they are used effectively in target populations 2.
Prevention and Vaccination
Prevention of RSV infection in elderly patients is limited to standard infection control practices, such as hand washing and the use of gowns and gloves 3.
- Two protein subunit vaccines for protection from severe RSV in adults aged 60 years and older were licensed in 2023, and a third - an mRNA-based vaccine - recently gained market approval in the USA 2.
- These vaccines have shown good protection against severe disease in phase 3 studies, but data on real-world vaccine effectiveness in older adults are needed to establish the best use of these newly approved RSV vaccines 2.
High-Risk Patients
Older persons with underlying heart and lung disease and immunocompromised patients are at highest risk for RSV infection-related pneumonia and death 3.