Treatment for RSV in Otherwise Healthy Adults
For otherwise healthy adults with RSV infection, treatment is entirely supportive care—there are no FDA-approved antiviral medications for RSV in this population. 1
Primary Management Approach
Supportive care is the cornerstone of RSV management in healthy adults, focusing on symptom relief and maintaining adequate oxygenation and hydration. 1, 2
Core Supportive Measures
- Oxygen supplementation should be provided to maintain adequate saturation, particularly if hypoxemic respiratory failure develops 1
- Adequate hydration through oral or intravenous fluids is essential for all patients 1
- Analgesics such as acetaminophen or ibuprofen can be used for fever and pain management 1
- Nasal saline irrigation may provide symptomatic relief for upper respiratory symptoms 1
What NOT to Do: Critical Pitfalls
- Do NOT use palivizumab for treatment of established RSV infection in adults—it has no therapeutic benefit and is only approved for prevention in high-risk infants 1
- Avoid routine corticosteroids in RSV management unless treating an underlying COPD or asthma exacerbation 1
- Do NOT prescribe antibiotics empirically—they should only be used when specific bacterial co-infection is documented 1, 3
When to Escalate Care
Respiratory Support Algorithm
If standard oxygen supplementation is insufficient:
- High-flow nasal oxygen (HFNO) may be considered in monitored settings with personnel capable of intubation 1
- Non-invasive ventilation (NIV) is NOT recommended due to high failure rates and risk of aerosol generation 1
- Early intubation and mechanical ventilation should be considered if respiratory distress worsens or oxygen requirements cannot be met 1
Diagnostic Considerations
- Nucleic acid-based testing (RT-PCR) is the recommended diagnostic method for RSV in adults 1
- Antigen detection tests are NOT recommended for adults due to poor sensitivity in this population 1
Prevention for Future Seasons
While this doesn't help with current infection, RSV vaccination is now available and should be discussed for future prevention, particularly as healthy adults age into higher-risk categories:
- All adults ≥75 years should receive RSV vaccination regardless of comorbidities 4
- Adults aged 60-74 years with risk factors (chronic cardiopulmonary disease, diabetes, chronic kidney disease, immunocompromised status, nursing home residence) should receive vaccination 4
- Vaccination should be administered between September and November, before RSV season begins 4, 3
- A single dose is recommended and can be co-administered with influenza vaccine 4, 3
Expected Clinical Course
Most otherwise healthy adults recover within 1-2 weeks with supportive care alone. 5 However, vigilance is needed as RSV can occasionally progress to more severe lower respiratory tract disease even in previously healthy individuals. 6