From the Guidelines
The treatment for Respiratory Syncytial Virus (RSV) infection is primarily supportive care, as there are no specific antiviral medications approved for routine use in most RSV cases. For mild to moderate RSV infections, treatment includes ensuring adequate hydration, fever control 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 humidified air to ease breathing.
Key Considerations
- For severe cases requiring hospitalization, supplemental oxygen may be provided to maintain oxygen saturation above 90%, and in critical cases, mechanical ventilation might be necessary 1.
- Ribavirin, an antiviral medication, is rarely used and only considered in severely immunocompromised patients.
- For high-risk infants (premature, with chronic lung disease, or congenital heart disease), palivizumab (Synagis) may be given as monthly prophylactic injections during RSV season to prevent severe disease, but it's not used as treatment once infection occurs 1.
High-Risk Infants
- Infants born at 32 weeks of gestation or earlier may benefit from RSV prophylaxis, even if they do not have chronic lung disease (CLD) 1.
- Infants born at 28 weeks of gestation or earlier may benefit from prophylaxis during their first RSV season, whenever that occurs during the first 12 months of life.
Prevention
- Maternal vaccination is believed to be a safer means of conferring immunity in infants against the virus, although no vaccines have yet been licensed for use 1.
- High-risk infants should be kept away from crowds and from situations in which exposure to infected individuals cannot be controlled, and participation in group child care should be restricted during the RSV season whenever feasible 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 (VIRAZOLE) for hospitalized infants and young children with severe lower respiratory tract infections due to RSV.
- The decision to treat with VIRAZOLE should be based on the severity of the RSV infection.
- Treatment may be initiated while awaiting rapid diagnostic test results, but should not be continued without documentation of RSV infection 2.
- VIRAZOLE is most effective when instituted within the first 3 days of clinical illness.
From the Research
Treatment Options for RSV Infection
- The treatment of RSV infection is primarily supportive, with interventions including supplemental oxygen therapy, ventilation, and fluid and nutrition therapy 3, 4, 5.
- Antiviral therapy, such as ribavirin, may be used for high-risk and severely ill patients, but its efficacy is limited and its use is not routinely recommended 4, 5, 6.
- Corticosteroids may be effective in cases of moderate to severe RSV infection, but their use is controversial and not universally recommended 3, 5, 6.
- Bronchodilators may have some short-term benefit, but are not recommended as standard practice for infants and children with RSV infection 3, 5.
Prophylaxis and Prevention
- Palivizumab, a monoclonal antibody, is effective in preventing RSV disease in high-risk infants, including those with chronic lung disease or congenital heart disease 3, 4, 5, 6, 7.
- Palivizumab is administered via intramuscular injection, typically on a monthly basis during RSV season (November to April) 3, 4.
- Other prevention strategies include washing hands, cleaning environment surfaces, and isolating infants and children with RSV in the emergency care area 3.
- Vaccination against RSV is in development, but not yet available 4, 5.
High-Risk Patients
- High-risk patients, including premature infants, those with congenital heart disease, chronic lung disease, or immunocompromised states, may benefit from prophylaxis with palivizumab 3, 4, 5, 6, 7.
- Combination therapy with intravenous palivizumab and ribavirin may be effective in treating severe RSV infection in high-risk patients, but more research is needed to confirm its efficacy 7.