Treatment Options for Respiratory Syncytial Virus (RSV) Symptoms
There is no specific antiviral treatment for RSV infection in most patients; management is primarily supportive care focused on symptom relief, with preventive measures being crucial to reduce transmission. 1, 2
Supportive Care Measures
- Hydration maintenance is essential for all patients with RSV infection, as respiratory distress and fever can lead to dehydration 2
- Supplemental oxygen should be provided for patients with hypoxemia or respiratory distress 3
- Nasal suctioning helps clear secretions in infants and young children with nasal congestion 4
- Fever management with appropriate antipyretics as needed 4
- High-flow nasal cannula may be beneficial in severe cases requiring hospitalization 3
- Mechanical ventilation may be necessary for patients with severe respiratory failure 2
Infection Control Measures
- Hand hygiene is the most important strategy for reducing RSV transmission - hands should be decontaminated before and after direct patient contact, after contact with objects in the patient's vicinity, and after removing gloves 1, 5
- Alcohol-based hand rubs are preferred for hand decontamination when hands are not visibly soiled 1
- Education of healthcare personnel and family members about hand hygiene and infection prevention is essential 1
- Isolation or cohorting of RSV-positive patients is effective in reducing nosocomial spread 1
- Contact precautions including gloves and gowns for direct patient contact help minimize transmission 1
- Restricting visitors with respiratory symptoms from visiting high-risk patients 1
Special Considerations for High-Risk Populations
Pediatric Patients
- Palivizumab (Synagis) is indicated for prevention (not treatment) of serious RSV disease in high-risk pediatric patients including:
- Premature infants born at ≤35 weeks gestation who are ≤6 months at the start of RSV season 6
- Infants with bronchopulmonary dysplasia requiring medical treatment within the previous 6 months who are ≤24 months at the start of RSV season 6
- Children with hemodynamically significant congenital heart disease who are ≤24 months at the start of RSV season 6
- Dosing: 15 mg/kg body weight given monthly by intramuscular injection throughout RSV season 6
- Limitations: Not established for treatment of active RSV disease 6
Adults ≥60 Years and High-Risk Adults
- RSV vaccination is recommended for:
- Available vaccines include RSVPreF3 (Arexvy) and RSVpreF (Abrysvo), administered as a single intramuscular dose, preferably between September and November 7, 1
Treatments Not Routinely Recommended
- Antibiotics are not helpful for bronchiolitis caused by RSV unless there is a concurrent bacterial infection, which is rare 4
- Corticosteroids have not shown benefit for RSV bronchiolitis 4
- Bronchodilators should only be continued if there is a prompt favorable response to an initial trial 4
- Ribavirin, though FDA-approved for RSV treatment in some cases, has limited clinical benefit and potential toxicity, and is not recommended for routine use 8
Considerations for Immunocompromised Patients
- Aerosolized or systemic ribavirin may be considered for treatment of RSV lower respiratory tract disease in allogeneic hematopoietic stem cell transplant recipients 1
- Intravenous immunoglobulin (IVIG) may be combined with ribavirin therapy in these high-risk patients 1
- Deferral of conditioning therapy should be considered for patients with RSV respiratory tract infection planned for allogeneic hematopoietic stem cell transplantation 1
Prevention Strategies
- Breastfeeding is recommended to decrease a child's risk of having lower respiratory infections 1
- Avoiding exposure to tobacco smoke is important as it increases the risk of severe RSV disease 1
- Avoiding crowded environments during RSV season for high-risk individuals 5
- RSV vaccines for pregnant women between weeks 24 and 36 of gestation can provide passive protection to infants from birth through 6 months of age 1, 9