Viral Pneumonia Medication

Updated: Jul 21, 2023
  • Author: Zab Mosenifar, MD, FACP, FCCP; Chief Editor: John J Oppenheimer, MD  more...
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Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

Few specific antiviral agents exist. Acyclovir (for varicella and herpes simplex pneumonia) is efficacious. Ganciclovir and immunoglobulin are used in immunocompromised patients with CMV pneumonia.

For further information on albuterol and inhaled corticosteroid use, see Asthma.


Antiviral agents

Class Summary

Acute lower respiratory tract infection from viral etiologies can be treated with antiviral agents. These agents inhibit DNA synthesis and viral replication by competing with deoxyguanosine triphosphate for viral DNA polymerase.

Agents used include amantadine, rimantadine, zanamivir, oseltamivir, ribavirin, acyclovir, ganciclovir, and foscarnet are used. The influenza drugs may be used as either prophylactic or therapeutic agents. Hyperimmune globulin is used primarily for passive immunization in some viral illnesses.

Zanamivir (Relenza)

Zanamivir inhibits neuraminidase, which is a glycoprotein on the surface of the influenza virus that destroys the infected cell's receptor for viral hemagglutinin. By inhibiting viral neuraminidase, the release of viruses from infected cells and viral spread are decreased. Zanamivir is effective against influenza types A and B. The drug is inhaled through the Diskhaler oral inhalation device. Circular foil discs containing 5-mg blisters of the drug are inserted into the supplied inhalation device.

Oseltamivir (Tamiflu)

Oseltamivir inhibits neuraminidase, which is a glycoprotein on the surface of influenza virus that destroys an infected cell's receptor for viral hemagglutinin. By inhibiting viral neuraminidase, it decreases the release of viruses from infected cells and thus viral spread. Oseltamivir is effective for treatment of influenza A or B infection, although resistant strains of seasonal influenza and H1N1 have been reported. Start within 40 hours of symptom onset.

Peramivir (Rapivab)

Peramivir elicits antiviral activity by inhibiting influenza virus neuraminidase, an enzyme that releases viral particles from the plasma membrane of infected cells. It is indicated for the treatment of acute uncomplicated influenza in adults and children aged 6 months and older who have been symptomatic for no more than 2 days. 

Ribavirin (Virazole)

Ribavirin inhibits viral replication by inhibiting DNA and RNA synthesis. It has shown in vitro antiviral properties against RSV, parainfluenza, hantavirus, measles, and many other.

Acyclovir (Zovirax)

Acyclovir inhibits activity of both HSV-1 and HSV-2. It has affinity for viral thymidine kinase and, once phosphorylated, causes DNA chain termination when acted on by DNA polymerase. Patients experience less pain and faster resolution of HSV or VZV lesions when used within 24-48 hours of rash onset. Early initiation of therapy is imperative.

Ganciclovir (Cytovene, Vitrasert)

Ganciclovir is a synthetic guanine derivative that is active against CMV, HSV, HHV-6, and HHV-8. It is an acyclic nucleoside analog of 2'-deoxyguanosine that inhibits replication of herpesviruses both in vitro and in vivo. levels of ganciclovir-triphosphate are as much as 100-fold greater in CMV-infected cells than in uninfected cells, possibly because of preferential phosphorylation of ganciclovir in virus-infected cells. An oral prodrug, valganciclovir, is now available.

Foscarnet (Foscavir)

Foscarnet is an organic analog of inorganic pyrophosphate that inhibits replication of known herpesviruses, including CMV, HSV-1, and HSV-2. It inhibits viral replication at pyrophosphate-binding sites on virus-specific DNA polymerases. Poor clinical response or persistent viral excretion during therapy may result from viral resistance. Patients who can tolerate foscarnet well may benefit from initiation of maintenance treatment at 120 mg/kg/d early in treatment. Individualize dosing based on renal function status.

Cidofovir (Vistide)

Cidofovir has demonstrated good in vitro activity against adenoviruses, including serotype 14. Cidofovir has shown some efficacy in treating adenovirus infection in immunocompromised patients, especially HSCT recipients.


Monoclonal Antibodies

Class Summary

Humanized monoclonal antibody directed against the F (fusion) protein of RSV are indicated for prophylaxis of newborns and young infants during or entering RSV season. 

Palivizumab (Synagis)

Given as a monthly IM injection through the RSV season, it has been demonstrated to decrease the chances of RSV hospitalization in premature babies who are at increased risk for severe RSV-related illness.

Nirsevimab (Beyfortus)

Administered as a single IM dose per season. It is indicated for prevention of respiratory syncytial virus (RSV) lower respiratory tract disease in neonates and infants born during or entering their first RSV season, and in children up to 24 months of age who remain vulnerable to severe RSV disease through their second RSV season. 


Immune Globulins

Class Summary

High-dose intravenous immunoglobulin has been used successfully in conjunction with ganciclovir for the treatment of CMV pneumonia.

Immune globulin IV (Gamimune, Gammagard, Sandoglobulin, Gammar-P)

Immune globulin IV neutralizes circulating myelin antibodies through anti-idiotypic antibodies. It down-regulates proinflammatory cytokines, including INF-gamma; blocks Fc receptors on macrophages; suppresses inducer T cells and B cells; and augments suppressor T cells. The drug also blocks the complement cascade, promotes remyelination, and may increase CSF IgG levels (10%).



Class Summary

Many patients with viral pneumonia have bronchospasm, which is relieved or improved with the use of beta-agonist drugs.

Albuterol (Proventil)

Albuterol is a beta-agonist used to treat bronchospasm. It relaxes bronchial smooth muscle with its action on beta2-receptors. It has little effect on cardiac muscle contractility.



Class Summary

Two RSV vaccines for older adults were approved in May 2023 to reduce morbidity and mortality from RSV infection.

Respiratory syncytial virus (RSV) vaccine, adjuvanted (Arexvy)

The vaccine contains a recombinant subunit prefusion RSV F glycoprotein antigen (RSVPreF3) combined with AS01E adjuvant. It is indicated for active immunization for prevention of lower respiratory tract disease caused by respiratory syncytial virus (RSV) infection in adults aged 60 years and older. 

Respiratory syncytial virus (RSV) vaccine (Abrysvo)

The vaccine is composed of equal amounts of recombinant RSV prefusion F from subgroups A and B. It is indicated for active immunization for prevention of lower respiratory tract disease caused by respiratory syncytial virus (RSV) infection in adults aged 60 years and older.