Medication Summary

Medications to treat respiratory syncytial virus (RSV) infection include the antiviral drug ribavirin, which can be used in severe high-risk cases, and bronchodilators. The efficacy of bronchodilators or racemic epinephrine in treating RSV disease remains unproved. If these agents are given, attempts to measure response to therapy should be documented. If these treatments have no demonstrable benefit, they should be discontinued. Palivizumab may be given for prophylaxis.

A study evaluated the effectiveness of current regimens for palivizumab injections across different cities in order to design an optimized regimen. The study found that a 5-injection regimen using city-specific initiation dates would reduce the risk of RSV hospitalization by a median of 6.8%.^{[35, 32]}A study by Lavoie et al found that abbreviated three-and four dose regimens had comparable outcomes to infants treated with the five-dose regimen.^[36]

Class Summary

Antiviral therapy for severe RSV disease may be indicated in high-risk patients. For effective inhibition of the replicating virus, treatment must be promptly initiated at the onset of the infection.

Ribavirin (Virazole)

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Ribavirin is an analogue of the nucleic acid guanosine. It inhibits viral replication through an unknown mechanism.

Class Summary

Bronchodilators act to decrease muscle tone in the small and large airways in the lungs, thereby increasing ventilation. Beta₂ -adrenergic and alpha-adrenergic agents are frequently administered (via inhalation) in an attempt to treat the bronchospasm observed in bronchiolitis.

Albuterol (AccuNeb, Proventil, ProAir HFA)

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As a selective beta2-agonist, albuterol produces bronchial smooth muscle relaxation. Its efficacy in older children with reactive airway disease is well established, but its benefits in children with acute bronchiolitis are less well established. It is available in inhaled and oral preparations.

Epinephrine racemic

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Racemic epinephrine consists of 1-1.125% of epinephrine base solution given by aerosol. It may be superior to beta2-adrenergic agents for treating RSV lower respiratory tract infection.

Class Summary

Specific immunoglobulin products with anti-RSV activity have been developed for the prophylaxis of high-risk patients against RSV infection.

Palivizumab (Synagis)

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Palivizumab is a humanized monoclonal antibody directed against the F (fusion) protein of RSV. Administered monthly 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. Owing to the shift in RSV seasonality noted in spring 2021 and the surge of RSV cases in fall 2022, the American Academy of Pediatrics supports providing more than 5 consecutive doses of palivizumab to eligible children in regions with disease activity lasting more than the typical 6-month duration.

Questions

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Media Gallery

Respiratory syncytial virus infection season, United States, by region and Florida. Image courtesy of Centers for Disease Control and Prevention.
Electron micrograph of respiratory syncytial virus (RSV). RSV is most common cause of bronchiolitis and pneumonia in children younger than 1 year. Image courtesy of Centers for Disease Control and Prevention.

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Author

Leonard R Krilov, MD Chief of Pediatric Infectious Diseases and International Adoption, Vice Chair, Department of Pediatrics, Winthrop University Hospital; Professor of Pediatrics, Stony Brook University School of Medicine

Leonard R Krilov, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Coauthor(s)

Asif Noor, MD Assistant Professor of Pediatric Infectious Diseases, NYU Long Island School of Medicine

Asif Noor, MD is a member of the following medical societies: American Academy of Pediatrics, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Ashir Kumar, MD, MB Professor Emeritus, Department of Pediatrics and Human Development, Michigan State University College of Human Medicine

Ashir Kumar, MD, MB is a member of the following medical societies: American Association of Physicians of Indian Origin and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Larry I Lutwick, MD Professor of Medicine, State University of New York Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus

Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Sections Respiratory Syncytial Virus Infection
Overview
Presentation
DDx
Workup
Treatment
Medication
Questions & Answers
Media Gallery
References

Respiratory Syncytial Virus Infection Medication

Medication Summary

Antiviral agents