Management of Respiratory Syncytial Virus Infection

Antiviral Treatment

The American Thoracic Society recommends considering ribavirin in severe cases of lower respiratory tract infection, especially in immunocompromised patients such as hematopoietic stem cell or lung transplant recipients, with limited efficacy, potential adverse effects, and high cost 1, 2
Ribavirin is not approved for routine use in adults, but it is used off-label in immunocompromised patients, with the oral form being less expensive and easier to administer than the aerosolized form 2
Other agents, such as presatovir, ALS-008176, and RSV604, are in development for the treatment of respiratory syncytial virus infection 2

The standard treatment for respiratory syncytial virus infection is primarily supportive measures, including control of fever, adequate hydration, and oxygen therapy for hypoxic patients, with no routine use of ribavirin recommended 1
The American Thoracic Society and the Infectious Diseases Society of America recommend supportive care measures, including fever management with antipyretics, adequate hydration, and oxygen therapy for hypoxic patients, with a strength of evidence rated as high 3, 4, 5, 2
The Society of Critical Care Medicine recommends focusing on supportive care measures, including fever management with antipyretics, adequate hydration, and oxygen therapy for hypoxic patients, for other viral respiratory infections 4

Hand hygiene with alcohol-based hand gels, respiratory/cough etiquette, and avoidance of contact with known infected individuals are essential infection control measures, as recommended by the Centers for Disease Control and Prevention 6, 3
Isolation of infected individuals, especially in healthcare settings, is crucial to prevent the spread of parainfluenza virus infection 6
Vaccination is currently available for older adults in the US, although its use is not universally recommended 3
Palivizumab (Synagis) is indicated as prophylaxis in preterm infants, children with chronic lung disease, congenital respiratory anomalies, and neuromuscular disease, as recommended by the American Academy of Pediatrics 7

In patients with hematologic malignancies, ribavirin may be considered in severe cases of respiratory syncytial virus infection, with an increased risk of viral complications in the presence of sustained T-cell function suppression 8
For hematopoietic stem cell transplant (HSCT) recipients with lower respiratory tract disease, consider ribavirin (aerosolized or systemic) as a treatment option, with aerosolized administration at 2g for 2h every 8h or 6g over 18h/day for 7-10 days, and oral or IV administration at 10-30 mg/kg body weight in 3 divided doses, while monitoring for adverse effects such as hemolysis, abnormal liver function, and declining renal function, according to the Infectious Diseases Society of America 9
Ribavirin oral or inhalated may be considered in bone marrow or lung transplant recipients, although its use is off-label and based on observational data, as noted by the American Thoracic Society 2

The Infectious Diseases Society recommends considering antibiotics in patients who develop worsening symptoms or those at high risk of complications, with preferred choices including co-amoxiclav or a tetracycline for non-severe cases, and broad-spectrum β-lactamase stable antibiotics for severe cases 5, 10, 3
Empiric antibiotics should be considered in cases of suspected bacterial superinfection, with coverage for S. pneumoniae, S. aureus, and H. influenzae, as recommended by the American College of Chest Physicians 3