What antiviral therapy is available for a patient with measles infection?

No Specific Antiviral Therapy Exists for Measles Infection

There is no FDA-approved antiviral medication for the treatment of measles virus infection. Management relies entirely on supportive care and vitamin A supplementation, which is the only evidence-based intervention proven to reduce measles mortality 1, 2, 3, 4.

Essential Treatment: Vitamin A Supplementation

All patients with clinical measles should receive vitamin A supplementation immediately, as this is the cornerstone of measles management:

• Adults and children ≥12 months: 200,000 IU orally on day 1 1, 2
• Children <12 months: 100,000 IU orally on day 1 2
• Complicated cases: Administer a second dose of the same amount on day 2 for patients developing pneumonia, otitis media, croup, diarrhea with dehydration, or neurological complications 1, 2
• Eye symptoms of vitamin A deficiency: Give 200,000 IU on day 1, repeat on day 2, and again 1-4 weeks later 1

The World Health Organization emphasizes that vitamin A reduces both morbidity and mortality from measles 1, 2.

Supportive Care Measures

Management focuses on treating complications as they arise:

• Bacterial superinfections: Use appropriate antibiotics for acute lower respiratory infections, otitis media, and other bacterial complications 1, 2
• Diarrhea: Oral rehydration therapy 1, 2
• Nutritional support: Monitor nutritional status and enroll in feeding programs if indicated 1
• Symptomatic relief: Antipyretics for fever, hydration support 4

Post-Exposure Prophylaxis (Not Treatment of Active Infection)

While not antivirals for active infection, these interventions can prevent or modify disease if given after exposure but before symptom onset:

• MMR vaccine: May provide protection if administered within 72 hours of exposure 2, 5
• Immune globulin (IG):
  • Immunocompromised patients: 0.5 mL/kg (maximum 15 mL) within 6 days of exposure 1, 2
  • Pregnant women: 0.25 mL/kg (maximum 15 mL) within 6 days of exposure 1, 2
  • Standard dose for others: 0.25 mL/kg 5

Experimental Antivirals (Not Clinically Available)

Research has identified potential antiviral compounds, but none are approved for clinical use:

• Fusion inhibitors: Brain-penetrant peptide inhibitors showed efficacy in animal models but remain experimental 6
• Ribavirin: Mentioned in some literature for severe cases but lacks robust evidence and is not standard of care 4
• Intravenous immunoglobulin (IVIG): WHO-advised option for severe cases, though not approved as standard of care 7, 4

Critical Infection Control

• Immediate isolation: For at least 4 days after rash onset (patients are contagious from 4 days before through 4 days after rash appearance) 1, 2
• N95 respirators: Required for all healthcare workers entering the room, regardless of immunity status 1, 2, 5
• Airborne precautions: Maintain throughout the infectious period 5

Common Pitfalls to Avoid

• Do not delay vitamin A supplementation while awaiting laboratory confirmation—administer based on clinical suspicion 1, 2
• Do not use regular surgical masks—N95 respirators are mandatory due to airborne transmission 1, 2
• Do not assume antibiotics treat measles itself—they only address bacterial superinfections 1, 2
• Do not confuse post-exposure prophylaxis with treatment of active infection—IG and MMR vaccine are ineffective once symptoms develop 2, 5

The absence of specific antiviral therapy underscores the critical importance of prevention through vaccination, as measles remains a disease without targeted pharmaceutical intervention once infection is established 8, 3.