What is the treatment for Respiratory Syncytial Virus (RSV) infection?

From the Guidelines

Treatment for Respiratory Syncytial Virus (RSV) infection is primarily supportive care, with a focus on ensuring adequate hydration, fever control, and respiratory support as needed, as there is no specific antiviral therapy approved for routine use. For most patients, 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)
• Nasal suctioning to clear secretions
• Humidified air Severe cases requiring hospitalization may need:
• Supplemental oxygen to maintain oxygen saturation above 90%
• Intravenous fluids for hydration
• Possibly mechanical ventilation for respiratory failure For high-risk infants (premature, with chronic lung disease, or congenital heart disease), palivizumab (Synagis) or nirsevimab can be given as monthly injections during RSV season for prevention, but it's not used as treatment 1. The antiviral ribavirin may be considered in severely immunocompromised patients but is not routinely recommended due to limited efficacy, high cost, and potential toxicity 1. Most RSV infections resolve within 1-2 weeks, though cough may persist longer. Antibiotics are not effective against RSV since it's a viral infection, but may be prescribed if a secondary bacterial infection develops. RSV is highly contagious, so practicing good hand hygiene and avoiding contact with infected individuals is important for prevention. The use of nirsevimab for the prevention of RSV disease among infants and young children has been recommended by the Advisory Committee on Immunization Practices (ACIP) in 2023 1. It's worth noting that controlled studies have demonstrated that monoclonal antibodies, such as palivizumab, have no therapeutic benefit in the treatment of RSV infected children 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 (INH), specifically VIRAZOLE (Ribavirin for Inhalation Solution, USP), for hospitalized infants and young children with severe lower respiratory tract infections due to RSV 2.

• Treatment should be initiated early in the course of severe lower respiratory tract infection to achieve efficacy.
• Severe RSV lower respiratory tract infection should be documented by a rapid diagnostic method before or during the first 24 hours of treatment.
• Treatment may be initiated while awaiting rapid diagnostic test results, but should not be continued without documentation of RSV infection.

From the Research

Treatment Options for RSV Infection

• Supportive care is the mainstay of management for RSV infection, as there is no specific treatment available 3, 4, 5, 6.
• In severe cases, oxygen therapy or mechanical ventilation may be necessary to support the patient's respiratory system 3, 4.
• High flow nasal cannula has been shown to be beneficial in severe cases of RSV infection 3.
• Bronchodilators may have some short-term benefit, but are not recommended as standard practice for infants and children with RSV infection 4, 5.
• Antiviral therapy, such as ribavirin, may be used for high-risk and severely ill patients, but its effectiveness is limited 4, 5, 6.
• Corticosteroids may be effective in cases of moderate to severe RSV infection, but their use is not recommended for mild cases 4, 5.

Prevention Strategies

• Immunoprophylaxis with monoclonal antibodies, such as palivizumab, has been shown to be effective in preventing RSV disease in high-risk patients 4, 6, 7.
• RSV vaccines are being developed, but their availability is not yet a reality 6, 7.
• Preventive measures, such as washing hands, cleaning environment surfaces, and isolating infants and children with RSV, can help reduce the transmission of the virus 4, 7.
• Education of caregivers and avoidance of exposure to environmental factors associated with severe forms of RSV infection are also important preventive measures 7.

High-Risk Patients

• High-risk patients, such as preterm infants, young children with chronic lung disease, and older adults with underlying medical conditions, may require more aggressive treatment and preventive measures 3, 4, 6.
• Palivizumab, an RSV monoclonal antibody, has been shown to be effective in preventing RSV disease in these high-risk populations 6.