From the Guidelines
Treatment for RSV in adults primarily focuses on supportive care, with no specific antiviral medications approved for routine use, and vaccination is recommended for adults aged ≥75 years and those aged 60-74 years who are at increased risk for severe RSV disease, as per the latest guidelines from the Advisory Committee on Immunization Practices 1. Adults with RSV should rest, stay hydrated, and take over-the-counter pain relievers like acetaminophen (Tylenol) 650 mg every 6 hours or ibuprofen (Advil, Motrin) 400-600 mg every 6-8 hours as needed for fever and discomfort. Some key points to consider in the treatment of RSV in adults include:
- Using a cool-mist humidifier to ease congestion and breathing difficulties
- Utilizing saline nasal sprays or over-the-counter decongestants like pseudoephedrine for nasal congestion
- Practicing good hand hygiene and limiting contact with others, especially vulnerable populations, until symptoms resolve
- Considering hospitalization for oxygen support, IV fluids, or respiratory assistance in severe cases, particularly for those who are immunocompromised, elderly, or have underlying cardiopulmonary conditions
- The potential use of antiviral ribavirin in severe cases, though its use is controversial and generally limited to severely immunocompromised patients, as noted in studies such as 1
- The importance of vaccination in preventing RSV-associated disease, with recommendations for its use in adults aged ≥60 years, especially those with comorbidities or advanced age, as discussed in studies like 1, 1, 1, and 1.
From the Research
Treatment for Respiratory Syncytial Virus (RSV) in Adults
The treatment for RSV in adults is primarily supportive, including:
- Fluids
- Antipyretics
- Oxygen support when needed 2 In addition to supportive care, antiviral treatments such as oral ribavirin may be used, particularly in immunocompromised patients 3, 4
Antiviral Treatment
Oral ribavirin has been shown to be a well-tolerated treatment for RSV infection in moderately to severely immunocompromised hosts 3 Aerosolized ribavirin is also used for treatment, but it is very costly, teratogenic, and inconvenient 3 Comparative prospective studies are needed to determine if oral ribavirin is the optimal therapy for RSV infection in this patient population 3, 4
Prevention and Future Directions
Preventing RSV disease would be possible through RSV vaccine development, and new long-acting monoclonal antibodies have demonstrated promising results in early clinical trials 5 Palivizumab, an RSV monoclonal antibody, has demonstrated effectiveness in disease prevention and is the only licensed immunoprophylaxis for RSV disease in specific high-risk pediatric populations 5
Challenges and Considerations
The use of aerosolized ribavirin is limited due to issues with efficacy, safety, and cost 5, 6 Patient isolation and psychological effects must be weighed against the benefit of therapy 6 There is a lack of high-quality, comparative trials on the use of aerosolized ribavirin for the treatment of RSV lower respiratory tract infections in adult hospitalized immunocompromised patients 6