What is the treatment for a 14-year-old patient with Respiratory Syncytial Virus (RSV) infection?

Treatment for a 14-Year-Old with RSV Infection

For a 14-year-old with RSV infection, treatment is entirely supportive care—there is no antiviral therapy indicated for immunocompetent adolescents. 1, 2

Primary Treatment Approach

The cornerstone of management consists of:

• Hydration maintenance through oral intake when possible, or nasogastric/intravenous routes if the patient cannot maintain adequate oral intake 3, 1
• Supplemental oxygen should be administered if oxygen saturation falls persistently below 90-92% via nasal cannula, head box, or face mask 3, 1
• Fever and pain management with acetaminophen or ibuprofen as needed 3, 1
• Nasal saline irrigation may provide symptomatic relief for upper respiratory symptoms 1

Respiratory Support Escalation

If standard oxygen supplementation fails:

• High-flow nasal oxygen (HFNO) is the first-line escalation when the patient fails standard oxygen supplementation 3
• Prepare for intubation immediately if any of the following occur: failure to maintain SaO2 >92% despite FiO2 >60%, recurrent apnea, or signs of respiratory failure 3
• Non-invasive ventilation (NIV) is NOT recommended for RSV infection due to high failure rates and risk of aerosol generation 1

What NOT to Do

• Do not use bronchodilators routinely—they provide no benefit for RSV infection 3, 1
• Do not use corticosteroids—they provide no benefit for mortality, morbidity, or quality of life 3, 1
• Do not prescribe antibiotics unless documented bacterial co-infection exists 3, 1, 2
• Do not use palivizumab—it has no therapeutic benefit for treating established RSV infection and is only approved for prevention in high-risk infants 1, 2

Special Consideration: Immunocompromised Status

If this 14-year-old is immunocompromised, the treatment approach changes significantly:

High-Risk Populations Requiring Ribavirin Consideration

Ribavirin therapy should be considered for adolescents with: 1, 4

• Hematopoietic stem cell transplant (HSCT) recipients with RSV lower respiratory tract infection
• Solid organ transplant recipients with severe RSV infection
• Profound lymphopenia (<100 cells/mm³)
• Active chemotherapy for malignancy
• Chronic immunosuppressive therapy including high-dose corticosteroids or biologics
• HIV infection with significant immunosuppression (CD4+ <200 cells/mm³)

Ribavirin Administration Options

For immunocompromised patients with RSV lower respiratory tract infection: 1, 4

• Aerosolized ribavirin is the FDA-approved primary option for hospitalized patients with severe lower respiratory tract RSV infection
• Oral/intravenous ribavirin can be administered systemically (10-30 mg/kg/day in 3 divided doses) for patients unable to take oral medication

Dosing schedule for systemic ribavirin: 1

• Day 1: 600 mg loading dose, then 200 mg every 8 hours
• Day 2: 400 mg every 8 hours
• Day 3 onward: Increase to maximum of 10 mg/kg body weight every 8 hours
• Renal adjustment: For creatinine clearance 30-50 mL/min, maximum 200 mg every 8 hours

Monitoring for Ribavirin Adverse Events

• Monitor for hemolysis, abnormal liver function tests, and declining renal function with systemic ribavirin 1
• Monitor for claustrophobia, bronchospasm, nausea, conjunctivitis, and declining pulmonary function with aerosolized ribavirin 1
• Avoid environmental exposure in pregnant healthcare workers due to teratogenic effects 1

Combination Therapy

• Consider combining ribavirin with intravenous immunoglobulin (IVIG) or anti-RSV-enriched antibody preparations for HSCT patients with lower respiratory tract disease 1

Infection Control Measures

• Hand hygiene is the single most important measure to prevent transmission—use alcohol-based rubs before and after patient contact 1, 2
• Implement contact and droplet precautions with gowns and gloves for direct patient contact 1
• Educate family members about preventing RSV spread 3, 1

Common Pitfalls to Avoid

• Do not defer treatment decisions waiting for "clinical improvement"—immunocompromised patients can deteriorate rapidly and require early aggressive intervention 1
• Do not continue bronchodilator therapy without documented clinical improvement 1
• Do not use inadequate infection control measures leading to nosocomial transmission 1