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

Treatment of Respiratory Syncytial Virus (RSV) Infection

The mainstay of treatment for RSV infection is supportive care, as there is no specific antiviral therapy approved for treatment of established RSV disease. 1

Primary Treatment Approach

• Supportive care measures are the cornerstone of RSV management, including:

  • Maintaining adequate hydration 1
  • Fever control with appropriate antipyretics 1
  • Respiratory support as needed for those with respiratory distress 1
  • Oxygen therapy for children with hypoxemia (oxygen saturation <90-92%) 1

• Nasal suctioning and positioning may help maintain airway patency in infants 1

• Antibiotics should not be routinely prescribed unless there is evidence of bacterial co-infection 1

Prophylaxis with Palivizumab

• Palivizumab (Synagis) is indicated for prevention of serious lower respiratory tract disease caused by RSV in specific high-risk pediatric patients, but has no therapeutic benefit for established RSV infection 2, 3

• Eligible populations for prophylaxis include:

  • Infants with history of premature birth (≤35 weeks gestational age) who are 6 months or younger at the beginning of RSV season 2
  • Children with bronchopulmonary dysplasia (BPD) requiring medical treatment within previous 6 months and who are 24 months or younger 2
  • Children with hemodynamically significant congenital heart disease who are 24 months or younger 2

• The recommended dose is 15 mg/kg body weight given monthly by intramuscular injection during RSV season 2

• Palivizumab has demonstrated a 55% overall decrease in RSV-related hospitalization in high-risk infants 2

• If a child receiving monthly palivizumab prophylaxis experiences breakthrough RSV hospitalization, monthly prophylaxis should be discontinued due to extremely low likelihood (<0.5%) of a second RSV hospitalization in the same season 3

Indications for Hospitalization

• Children with the following should be considered for hospitalization:
  • Severe respiratory distress 1
  • Inability to maintain adequate hydration 1
  • Oxygen saturation <90% despite supplemental oxygen 1
  • Underlying high-risk conditions (prematurity, chronic lung disease, congenital heart disease, immunocompromised status) 1

Special Considerations for High-Risk Populations

• For immunocompromised children with RSV infection, oral or aerosolized ribavirin may be considered in select cases, though evidence for its effectiveness is limited 1, 4

• Children with profound lymphopenia require closer monitoring due to higher risk of progression to lower respiratory tract disease 1

• For children with pulmonary abnormality or neuromuscular disease that impairs secretion clearance, additional respiratory support may be needed 3

Infection Control Measures

• Strict adherence to infection-control practices is essential to prevent RSV transmission, particularly in healthcare settings 3

• Hand hygiene is the most important step in preventing nosocomial spread of RSV 3

• Alcohol-based rubs are preferred for hand decontamination, with antimicrobial soap washing as an alternative 3

• Education of healthcare personnel and family members on hand sanitation is recommended 3

Common Pitfalls to Avoid

• Palivizumab has no therapeutic benefit in treating established RSV infection and should not be used for this indication 3

• Routine use of palivizumab prophylaxis is not recommended for patients with cystic fibrosis unless other qualifying indications are present 3

• Prophylaxis is not recommended for primary asthma prevention or to reduce subsequent episodes of wheezing 3

• If prophylaxis is initiated in October, the fifth and final dose should be administered in February to provide protection through March 3

By following these evidence-based guidelines for the management of RSV infection, clinicians can optimize outcomes for affected children while appropriately utilizing available preventive strategies for high-risk populations.