Respiratory Syncytial Virus Infection Medication

Updated: Nov 21, 2022
  • Author: Leonard R Krilov, MD; Chief Editor: Russell W Steele, MD  more...
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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]


Antiviral agents

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)

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


Beta2 Agonists

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)

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

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.


Monoclonal Antibodies

Class Summary

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

Palivizumab (Synagis)

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.