Treatment of RSV

Treatment is largely symptomatic.

Main aim of management is to maintain hydration and oxygenation (1).

• dehydration in children with bronchiolitis may occur secondary to increased respiratory rate, fever, and poor feeding caused by difficulty breathing and nasal secretions.
  • IV fluids should be considered in infants with severe respiratory difficulty, a respiratory rate greater than 80 breaths per minute, or those who visibly tire during feeding
• intubation and ventilatory assistance are given if there is severe hypoxia
• humidified oxygen may be required if arterial oxygen tension is low.
  • should be used in children with saturations below 90 %

A single trial of a bronchodilator may be useful in children with wheezing but routine use is not recommended (1).

Corticosteroids (oral and inhaled) may be useful in older children with a history of asthma (1).

Ribavarin, a nucleoside analogue which is active in vitro against RSV, has been shown to relieve lower respiratory tract illness in children.

• it is used by inhalation since oral administration is associated with liver and bone marrow toxicity
• not recommended for routine use, reserved for immunosuppressed children with severe RSV infection (1)
• studies have yet to be conducted in adults

Reference:

• (1) Dawson-Caswell M, Muncie HL Jr. Respiratory syncytial virus infection in children. Am Fam Physician. 2011;83(2):141-6.