Treatment Options for Respiratory Syncytial Virus (RSV) Symptoms
The primary treatment for RSV symptoms is supportive care, as there are no specific FDA-approved antiviral treatments for general RSV infections in most patients. 1 Treatment approaches differ based on patient population and risk factors.
General Treatment Approach for Most Patients
Supportive Care
- Hydration and nutrition maintenance
- Oral hydration when possible
- Nasogastric or intravenous routes if needed 2
- Oxygen supplementation to maintain oxygen saturation >90% 2
- Symptom management:
- Nasal saline irrigation for congestion
- Acetaminophen or ibuprofen for fever and pain
- Antihistamines for rhinorrhea
- Oral decongestants (with caution in patients with certain comorbidities) 1
What to Avoid
- Antibiotics are NOT indicated for viral RSV infections 1
- Not recommended: bronchodilators, epinephrine, nebulized hypertonic saline, corticosteroids, and chest physiotherapy 2
Special Populations
High-Risk Pediatric Patients
For infants and children at high risk of severe RSV disease:
- Palivizumab (Synagis) - preventive immunoprophylaxis for:
- Premature infants ≤35 weeks gestational age who are ≤6 months at RSV season start
- Children ≤24 months with bronchopulmonary dysplasia requiring treatment within previous 6 months
- Children ≤24 months with hemodynamically significant congenital heart disease 3
- Administered monthly during RSV season at 15 mg/kg IM 3
Immunocompromised Patients
For immunocompromised patients with RSV infection, especially hematopoietic stem cell transplant (HSCT) recipients:
Ribavirin may be considered:
- Aerosolized ribavirin: 2g every 8 hours or 6g over 18h/day for 7-10 days 4
- Oral ribavirin: Alternative to aerosolized form (less expensive and easier to administer) 4
- IV ribavirin: For patients unable to take oral medication (10-30 mg/kg in 3 divided doses) 4
- May be combined with IVIG or RSV-specific antibody preparations in allogeneic HSCT patients 4
Monitoring during ribavirin treatment:
- For aerosolized: claustrophobia, bronchospasm, nausea, conjunctivitis, declining pulmonary function
- For systemic: hemolysis, abnormal liver function, declining renal function 4
Infection Control Measures
- Hand hygiene - most effective prevention method 1
- Isolation precautions for hospitalized patients 4
- Visitor restrictions - do not allow persons with respiratory symptoms to visit high-risk patients 4
- Personnel restrictions - limit healthcare workers with respiratory infections from caring for high-risk patients 4
Monitoring and Follow-up
- Return for medical evaluation if:
- Fever >38°C persists for more than 48 hours
- Breathing difficulty develops
- Symptoms worsen 1
- Follow-up within 72 hours if symptoms worsen or fail to improve 1
- Closer monitoring for immunocompromised patients who may develop more severe disease 1
Prevention
- RSV vaccination is now recommended for:
- Adults aged ≥60 years
- People aged ≥50 years with risk factors (COPD, asthma, heart failure, diabetes, chronic kidney/liver disease) 4
- Palivizumab prophylaxis for high-risk infants during RSV season 4
Important Caveats
- RSV diagnosis should be confirmed in high-risk patients to guide treatment and infection control 4
- Despite prophylaxis or treatment, patients may still develop severe RSV disease 3
- The cost-effectiveness of ribavirin remains debated due to its high cost and questionable adverse effect profile 5
- Treatment decisions for immunocompromised patients should consider risk factors for progression to lower respiratory tract disease 4