RSV Treatment
The treatment of RSV infection is primarily supportive care—including hydration, oxygen supplementation when SpO2 falls below 90%, and fever management—with antiviral therapy (ribavirin) reserved only for severely ill immunocompromised patients or those requiring mechanical ventilation. 1, 2
Core Treatment Principles
Supportive Care (All Patients)
- Maintain adequate hydration and assess fluid intake regularly, as this is the foundation of RSV management 1
- Provide supplemental oxygen if oxygen saturation persistently falls below 90% in previously healthy infants 1
- Use acetaminophen or ibuprofen for fever or pain control 1
- Nasal saline irrigation may provide symptomatic relief in adults with upper respiratory symptoms 1
What NOT to Use
- Do not use corticosteroids routinely in bronchiolitis management 1
- Do not use ribavirin routinely in children with bronchiolitis 1
- Do not prescribe antibiotics unless there is specific evidence of bacterial co-infection 1, 2
- Never use palivizumab for treatment—it has no therapeutic benefit for established RSV infection and is only approved for prevention in high-risk infants 1, 2
Antiviral Therapy (Select Populations Only)
Indications for Ribavirin
- Hematopoietic stem cell transplant patients with RSV lower respiratory tract disease should receive aerosolized ribavirin 1
- Hospitalized infants and young children with severe lower respiratory tract infections requiring mechanical ventilation may be treated with aerosolized ribavirin 3
- RSV infection must be documented by rapid diagnostic method before or during the first 24 hours of treatment 1, 3
- Treatment is most effective when instituted within the first 3 days of clinical illness 3
Ribavirin Administration Options
- Aerosolized ribavirin is the primary route for severe RSV lower respiratory tract infection 1
- Oral or intravenous ribavirin can be used for patients unable to take oral medication or as an alternative that may reduce progression to lower respiratory tract infection 1, 2
- Combination therapy with intravenous immunoglobulin or anti-RSV-enriched antibody preparations may be considered for hematopoietic stem cell transplant patients 1
Respiratory Support
- Oxygen therapy is necessary for children with hypoxemia (SpO2 <90-92%) 2
- High flow nasal cannula appears beneficial in severe cases 4
- Mechanical ventilation may be required for respiratory failure 3
- In mechanically ventilated patients treated with ribavirin, use heated wire tubing, bacterial filters in series (changed every 4 hours), and water column pressure release valves to prevent drug precipitation and ventilator malfunction 3
Hospitalization Criteria
- Admit infants with severe respiratory distress, inability to maintain hydration, or SpO2 <90% despite supplemental oxygen 2
- Children with underlying conditions (prematurity, chronic lung disease, congenital heart disease, immunocompromised status) require earlier hospitalization due to higher risk of severe disease 2
- Children with profound lymphopenia are at higher risk for progression to lower respiratory tract disease and need closer monitoring 2
Monitoring
- As clinical course improves, continuous SpO2 monitoring is not routinely needed 1
- Infants with hemodynamically significant heart or lung disease and premature infants require close monitoring during oxygen weaning 1
Critical Pitfalls to Avoid
- Avoid overusing antibiotics when there is no evidence of bacterial co-infection 1
- Do not continue bronchodilator therapy without documented clinical improvement 1
- Ensure adequate infection control measures—hand decontamination before and after patient contact is the most important step in preventing nosocomial spread 1
- Use alcohol-based rubs for hand decontamination 1