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Respiratory syncytial virus infection: Treatment

Authors
Frederick E Barr, MD
Barney S Graham, MD, PhD
Section Editors
Morven S Edwards, MD
George B Mallory, MD
Deputy Editor
Mary M Torchia, MD

INTRODUCTION

Respiratory syncytial virus (RSV) causes acute respiratory tract illness in persons of all ages. Almost all children are infected by two years of age, and reinfection is common [1]. The clinical manifestations vary with age, health status, and whether the infection is primary or secondary.

The treatment of respiratory syncytial virus infection in infants, children, and adults will be discussed here. The epidemiology, microbiology, clinical manifestations, diagnosis, and prevention of RSV infection are discussed separately. (See "Respiratory syncytial virus infection: Clinical features and diagnosis" and "Respiratory syncytial virus infection: Prevention".)

OVERVIEW

The discussion that follows assumes that the patient's illness is severe enough to require hospital admission or to pursue an etiologic diagnosis since specific etiologic diagnosis is usually not sought in otherwise healthy patients with mild respiratory tract infections who are treated symptomatically as outpatients. (See "Respiratory syncytial virus infection: Clinical features and diagnosis", section on 'Diagnosis'.)

Indications for hospitalization in children with bronchiolitis are discussed separately. (See "Bronchiolitis in infants and children: Treatment; outcome; and prevention", section on 'Indications for hospitalization'.)

Outpatient treatment for patients with upper respiratory tract infections, bronchiolitis, or pneumonia who do not have a specific microbiologic diagnosis are discussed separately. (See "Community-acquired pneumonia in children: Outpatient treatment", section on 'Empiric therapy' and "The common cold in children: Management and prevention" and "Bronchiolitis in infants and children: Treatment; outcome; and prevention", section on 'Nonsevere bronchiolitis'.)

                   

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Literature review current through: Nov 2016. | This topic last updated: Tue Jul 28 00:00:00 GMT+00:00 2015.
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References
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  1. Committee on Infectious Diseases. From the American Academy of Pediatrics: Policy statements--Modified recommendations for use of palivizumab for prevention of respiratory syncytial virus infections. Pediatrics 2009; 124:1694.
  2. Wald TG, Miller BA, Shult P, et al. Can respiratory syncytial virus and influenza A be distinguished clinically in institutionalized older persons? J Am Geriatr Soc 1995; 43:170.
  3. Henderson FW, Collier AM, Clyde WA Jr, Denny FW. Respiratory-syncytial-virus infections, reinfections and immunity. A prospective, longitudinal study in young children. N Engl J Med 1979; 300:530.
  4. Whimbey E, Couch RB, Englund JA, et al. Respiratory syncytial virus pneumonia in hospitalized adult patients with leukemia. Clin Infect Dis 1995; 21:376.
  5. Seo S, Campbell AP, Xie H, et al. Outcome of respiratory syncytial virus lower respiratory tract disease in hematopoietic cell transplant recipients receiving aerosolized ribavirin: significance of stem cell source and oxygen requirement. Biol Blood Marrow Transplant 2013; 19:589.
  6. Renaud C, Xie H, Seo S, et al. Mortality rates of human metapneumovirus and respiratory syncytial virus lower respiratory tract infections in hematopoietic cell transplantation recipients. Biol Blood Marrow Transplant 2013; 19:1220.
  7. Hartling L, Bialy LM, Vandermeer B, et al. Epinephrine for bronchiolitis. Cochrane Database Syst Rev 2011; :CD003123.
  8. Hartling L, Fernandes RM, Bialy L, et al. Steroids and bronchodilators for acute bronchiolitis in the first two years of life: systematic review and meta-analysis. BMJ 2011; 342:d1714.
  9. Skjerven HO, Hunderi JO, Brügmann-Pieper SK, et al. Racemic adrenaline and inhalation strategies in acute bronchiolitis. N Engl J Med 2013; 368:2286.
  10. Gadomski AM, Scribani MB. Bronchodilators for bronchiolitis. Cochrane Database Syst Rev 2014; :CD001266.
  11. Cade A, Brownlee KG, Conway SP, et al. Randomised placebo controlled trial of nebulised corticosteroids in acute respiratory syncytial viral bronchiolitis. Arch Dis Child 2000; 82:126.
  12. van Woensel JB, Vyas H, STAR Trial Group. Dexamethasone in children mechanically ventilated for lower respiratory tract infection caused by respiratory syncytial virus: a randomized controlled trial. Crit Care Med 2011; 39:1779.
  13. Patel H, Platt R, Lozano JM, Wang EE. Glucocorticoids for acute viral bronchiolitis in infants and young children. Cochrane Database Syst Rev 2004; :CD004878.
  14. Lozano JM. Bronchiolitis. Clin Evid 2004; :370.
  15. King VJ, Viswanathan M, Bordley WC, et al. Pharmacologic treatment of bronchiolitis in infants and children: a systematic review. Arch Pediatr Adolesc Med 2004; 158:127.
  16. Ventre K, Randolph A. Ribavirin for respiratory syncytial virus infection of the lower respiratory tract in infants and young children. Cochrane Database Syst Rev 2004; :CD000181.
  17. Ottolini MG, Hemming VG. Prevention and treatment recommendations for respiratory syncytial virus infection. Background and clinical experience 40 years after discovery. Drugs 1997; 54:867.
  18. Hall CB, McBride JT, Walsh EE, et al. Aerosolized ribavirin treatment of infants with respiratory syncytial viral infection. A randomized double-blind study. N Engl J Med 1983; 308:1443.
  19. Taber LH, Knight V, Gilbert BE, et al. Ribavirin aerosol treatment of bronchiolitis associated with respiratory syncytial virus infection in infants. Pediatrics 1983; 72:613.
  20. Rodriguez WJ, Kim HW, Brandt CD, et al. Aerosolized ribavirin in the treatment of patients with respiratory syncytial virus disease. Pediatr Infect Dis J 1987; 6:159.
  21. Smith DW, Frankel LR, Mathers LH, et al. A controlled trial of aerosolized ribavirin in infants receiving mechanical ventilation for severe respiratory syncytial virus infection. N Engl J Med 1991; 325:24.
  22. Meert KL, Sarnaik AP, Gelmini MJ, Lieh-Lai MW. Aerosolized ribavirin in mechanically ventilated children with respiratory syncytial virus lower respiratory tract disease: a prospective, double-blind, randomized trial. Crit Care Med 1994; 22:566.
  23. Moler FW, Steinhart CM, Ohmit SE, Stidham GL. Effectiveness of ribavirin in otherwise well infants with respiratory syncytial virus-associated respiratory failure. Pediatric Critical Study Group. J Pediatr 1996; 128:422.
  24. Guerguerian AM, Gauthier M, Lebel MH, et al. Ribavirin in ventilated respiratory syncytial virus bronchiolitis. A randomized, placebo-controlled trial. Am J Respir Crit Care Med 1999; 160:829.
  25. American Academy of Pediatrics. Respiratory syncytial virus. In: Red Book: 2015 Report of the Committee on Infectious Diseases, 30th ed, Kimberlin DW, Brady MT, Jackson MA, Long SS (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2015. p.667.
  26. McColl MD, Corser RB, Bremner J, Chopra R. Respiratory syncytial virus infection in adult BMT recipients: effective therapy with short duration nebulised ribavirin. Bone Marrow Transplant 1998; 21:423.
  27. Waghmare A, Campbell AP, Xie H, et al. Respiratory syncytial virus lower respiratory disease in hematopoietic cell transplant recipients: viral RNA detection in blood, antiviral treatment, and clinical outcomes. Clin Infect Dis 2013; 57:1731.
  28. Casey J, Morris K, Narayana M, et al. Oral ribavirin for treatment of respiratory syncitial virus and parainfluenza 3 virus infections post allogeneic haematopoietic stem cell transplantation. Bone Marrow Transplant 2013; 48:1558.
  29. Gueller S, Duenzinger U, Wolf T, et al. Successful systemic high-dose ribavirin treatment of respiratory syncytial virus-induced infections occurring pre-engraftment in allogeneic hematopoietic stem cell transplant recipients. Transpl Infect Dis 2013; 15:435.
  30. Krinzman S, Basgoz N, Kradin R, et al. Respiratory syncytial virus-associated infections in adult recipients of solid organ transplants. J Heart Lung Transplant 1998; 17:202.
  31. Doud JR, Hinkamp T, Garrity ER Jr. Respiratory syncytial virus pneumonia in a lung transplant recipient: case report. J Heart Lung Transplant 1992; 11:77.
  32. Rebetol (ribivarin) www.merck.com/product/usa/pi_circulars/r/rebetol/rebetol_pi.pdf (Accessed on December 19, 2013).
  33. Hospital investigations: Health Hazards. In: OSHA Technical Manual (OTM). US Department of Labor; Occupational Safety and Health Administration, Washington, DC 1999.
  34. Fuller H, Del Mar C. Immunoglobulin treatment for respiratory syncytial virus infection. Cochrane Database Syst Rev 2006; :CD004883.
  35. Hemming VG, Rodriguez W, Kim HW, et al. Intravenous immunoglobulin treatment of respiratory syncytial virus infections in infants and young children. Antimicrob Agents Chemother 1987; 31:1882.
  36. Rodriguez WJ, Gruber WC, Welliver RC, et al. Respiratory syncytial virus (RSV) immune globulin intravenous therapy for RSV lower respiratory tract infection in infants and young children at high risk for severe RSV infections: Respiratory Syncytial Virus Immune Globulin Study Group. Pediatrics 1997; 99:454.
  37. Rodriguez WJ, Gruber WC, Groothuis JR, et al. Respiratory syncytial virus immune globulin treatment of RSV lower respiratory tract infection in previously healthy children. Pediatrics 1997; 100:937.
  38. Sáez-Llorens X, Moreno MT, Ramilo O, et al. Safety and pharmacokinetics of palivizumab therapy in children hospitalized with respiratory syncytial virus infection. Pediatr Infect Dis J 2004; 23:707.
  39. Corti D, Bianchi S, Vanzetta F, et al. Cross-neutralization of four paramyxoviruses by a human monoclonal antibody. Nature 2013; 501:439.
  40. McLellan JS, Chen M, Leung S, et al. Structure of RSV fusion glycoprotein trimer bound to a prefusion-specific neutralizing antibody. Science 2013; 340:1113.
  41. Boyoglu-Barnum S, Gaston KA, Todd SO, et al. A respiratory syncytial virus (RSV) anti-G protein F(ab')2 monoclonal antibody suppresses mucous production and breathing effort in RSV rA2-line19F-infected BALB/c mice. J Virol 2013; 87:10955.
  42. Falsey AR, Walsh EE. Respiratory syncytial virus infection in adults. Clin Microbiol Rev 2000; 13:371.
  43. Hertz MI, Englund JA, Snover D, et al. Respiratory syncytial virus-induced acute lung injury in adult patients with bone marrow transplants: a clinical approach and review of the literature. Medicine (Baltimore) 1989; 68:269.
  44. Whimbey E, Champlin RE, Englund JA, et al. Combination therapy with aerosolized ribavirin and intravenous immunoglobulin for respiratory syncytial virus disease in adult bone marrow transplant recipients. Bone Marrow Transplant 1995; 16:393.
  45. Ghosh S, Champlin RE, Englund J, et al. Respiratory syncytial virus upper respiratory tract illnesses in adult blood and marrow transplant recipients: combination therapy with aerosolized ribavirin and intravenous immunoglobulin. Bone Marrow Transplant 2000; 25:751.
  46. DeVincenzo JP, Hirsch RL, Fuentes RJ, Top FH Jr. Respiratory syncytial virus immune globulin treatment of lower respiratory tract infection in pediatric patients undergoing bone marrow transplantation - a compassionate use experience. Bone Marrow Transplant 2000; 25:161.
  47. De Vincenzo JP, Leombruno D, Soiffer RJ, Siber GR. Immunotherapy of respiratory syncytial virus pneumonia following bone marrow transplantation. Bone Marrow Transplant 1996; 17:1051.
  48. Flynn JD, Akers WS, Jones M, et al. Treatment of respiratory syncytial virus pneumonia in a lung transplant recipient: case report and review of the literature. Pharmacotherapy 2004; 24:932.
  49. Schmidt AC, Johnson TR, Openshaw PJ, et al. Respiratory syncytial virus and other pneumoviruses: a review of the international symposium--RSV 2003. Virus Res 2004; 106:1.
  50. Glanville AR, Scott AI, Morton JM, et al. Intravenous ribavirin is a safe and cost-effective treatment for respiratory syncytial virus infection after lung transplantation. J Heart Lung Transplant 2005; 24:2114.
  51. Reprotox. Ribavirin. www.reprotox.org/Members/AgentDetail.aspx?a=1334 (Accessed on December 19, 2013).
  52. Roberts SS, Miller RK, Jones JK, et al. The Ribavirin Pregnancy Registry: Findings after 5 years of enrollment, 2003-2009. Birth Defects Res A Clin Mol Teratol 2010; 88:551.