From the Guidelines
Steroids are not recommended for the treatment of RSV infection due to the lack of evidence supporting their effectiveness and potential for increasing RSV loads and prolonged shedding. The use of corticosteroids in RSV infection is controversial, and current guidelines suggest that their role is limited 1. The evidence from studies, such as the fourth European conference on infections in leukaemia (ECIL-4), indicates that improving respiratory function with corticosteroids has been seen despite increasing RSV loads and prolonged shedding 1.
Key Points to Consider
- The pathophysiology of RSV involves viral inflammation, which may not respond well to steroids
- Treatment for RSV focuses on supportive care, including adequate hydration, nasal suctioning, and oxygen supplementation when needed
- Specific antiviral medications, like ribavirin and intravenous immunoglobulin (IVIG), may be considered for high-risk patients with severe disease, but the evidence for their effectiveness is limited 1
- Steroids may be appropriate for patients with RSV who also have a clear indication for steroids, such as concurrent asthma exacerbation, but this would be for the specific condition rather than for the RSV infection itself
Patient Populations at Risk
- Patients with severe immunodeficiency, older age (>65 y), and those with hematopoietic stem cell transplantation (HSCT) <1 mo are at higher risk for severe RSV infection 1
- These patients may require more aggressive supportive care and consideration of antiviral medications, but the use of steroids is not routinely recommended 1
From the Research
Steroid Use for RSV Treatment
- The use of steroids for the treatment of Respiratory Syncytial Virus (RSV) infection has been studied in various patient populations, including infants, children, and adults 2, 3, 4, 5, 6.
- In infants and children, the effectiveness of steroids in treating RSV infection is still unclear, with some studies suggesting a potential benefit in certain subgroups, such as those with mild oxygenation abnormalities 4, 6.
- However, other studies have found no significant difference in outcomes between patients treated with steroids and those who received placebo 3, 6.
- In adults, the use of steroids for RSV infection has been associated with a blunted antibody response, but no significant difference in viral load or shedding 5.
Specific Steroid Studies
- A study published in 2003 found that dexamethasone had a beneficial effect in patients with bronchiolitis, but not in those with pneumonia 4.
- A 2011 study found that short courses of systemic steroids in patients hospitalized with RSV infection did not affect viral load or shedding, but may have mildly diminished humoral immunity 5.
- Another 2011 study found no evidence of a beneficial effect of dexamethasone in children mechanically ventilated for severe RSV-lower respiratory tract infection, regardless of oxygenation status 6.
Treatment Options
- Current treatment options for RSV infection are limited, and supportive care remains the mainstay of treatment 2, 3.
- Ribavirin, corticosteroids, and bronchodilators are not used routinely due to lack of sufficient evidence of their effectiveness 2, 3.
- Palivizumab is beneficial in prophylaxis for infants at high-risk for severe RSV infection, but optimal indications based on cost-effectiveness considerations have not been defined 3.