Which medications are used for the treatment of respiratory syncytial virus (RSV) pneumonia?

Updated: Mar 24, 2021
  • Author: Zab Mosenifar, MD, FACP, FCCP; Chief Editor: John J Oppenheimer, MD  more...
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As with influenza, treatment of uncomplicated respiratory syncytial virus (RSV) infection is supportive in nature.

Ribavirin, a nucleoside analog of guanosine, is the only effective antiviral agent currently available for the treatment of RSV pneumonia. [1] Ribavirin acts by interfering with viral transcription. This drug is delivered as a small-particle aerosol. Data conflict regarding the efficacy of ribavirin therapy in RSV pneumonia. Overall, the preponderance of data suggests a benefit of ribavirin therapy in high-risk patients, such as hematopoietic stem cell transplant (HSCT) recipients.

Current recommendations are that ribavirin therapy should be considered only for severe illness and in high-risk patients for whom RSV infection is associated with high mortality, such as HSCT recipients. [61] In these hosts, high-dose, short-duration aerosolized ribavirin (60 mg/mL for 2 h given by mask tid) has been used.

RSV-specific intravenous immunoglobulin, such as palivizumab (Synagis), which is a monoclonal antibody directed against the RSV fusion (F) glycoprotein, has also been used with aerosolized and oral ribavirin in high-risk patients, such as HSCT recipients, because this combination has been shown to increase survival in this group. [56] Its use is endorsed in some guidelines, although not universally accepted or recommended. [87, 88]

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