Human respiratory syncytial virus medical therapy: Difference between revisions

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==Overivew==
==Overview==
Supportive treatment is the mainstay of therapy for infections caused by human respiratory syncytial virus.  Supportive care includes adequate hydration and supplemental oxygen therapy.


==Medical Therapy==
==Antimicrobial therapy==
[[Ribavirin]], a broad-spectrum antiviral agent, was once employed as adjunctive therapy for the sickest patients; however, its efficacy has been called into question by multiple studies, and most institutions no longer use it.
* Respiratory syncytial virus treatment
 
:* Supportive therapy
Treatment is otherwise supportive care only with fluids and oxygen until the illness runs its course.
::* Hydration and supplemental oxygen.
::* Routine use of [[Ribavirin]] not recommended. [[Ribavirin]] therapy associated with small increases in O2 saturation.
::* No consistent decrease in need for mechanical ventilation or ICU stays. High cost, aerosol administration and potential toxicity<ref name="pmid19736258">{{cite journal| author=Committee on Infectious Diseases| title=From the American Academy of Pediatrics: Policy statements--Modified recommendations for use of palivizumab for prevention of respiratory syncytial virus infections. | journal=Pediatrics | year= 2009 | volume= 124 | issue= 6 | pages= 1694-701 | pmid=19736258 | doi=10.1542/peds.2009-2345 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19736258  }} </ref>
::* Note (1): In adults, Respiratory syncytial virus accounted for 10.6% of hospitalizations for pneumonia, 11.4% for COPD, 7.2% for asthma & 5.4% for CHF in pts >65 yrs of age <ref name="pmid15858184">{{cite journal| author=Falsey AR, Hennessey PA, Formica MA, Cox C, Walsh EE| title=Respiratory syncytial virus infection in elderly and high-risk adults. | journal=N Engl J Med | year= 2005 | volume= 352 | issue= 17 | pages= 1749-59 | pmid=15858184 | doi=10.1056/NEJMoa043951 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15858184  }} </ref>. Respiratory syncytial virus caused 11% of clinically important respiratory illnesses in military recruits<ref name="pmid16007526">{{cite journal| author=O'Shea MK, Ryan MA, Hawksworth AW, Alsip BJ, Gray GC| title=Symptomatic respiratory syncytial virus infection in previously healthy young adults living in a crowded military environment. | journal=Clin Infect Dis | year= 2005 | volume= 41 | issue= 3 | pages= 311-7 | pmid=16007526 | doi=10.1086/431591 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16007526  }} </ref>
::* Note (2): Respiratory Syncytial Virus major cause of morbidity in neonates/infants.
::* Note (3): Nucleic acid test now approved to detect 12 respiratory viruses (xTAG Respiratory Viral Panel, Luminex Molecular Diagnostics).
:* '''Prevention of Respiratory syncytial virus'''
::* 1. In children <24 months old with chronic lung disease of prematurity (formerly broncho-pulmonary dysplasia) requiring supplemental oxygen or
::* 2. In premature infants (<32 wks gestation) and <6 months old at start of Respiratory syncytial virus season or
::* 3. In children with selected congenital heart diseases.
:::* Preferred regimen for prevention of Respiratory syncytial virus: [[Palivizumab]] (Synagis) 15 mg per kg IM q month Nov.-April<ref name="pmid19736258">{{cite journal| author=Committee on Infectious Diseases| title=From the American Academy of Pediatrics: Policy statements--Modified recommendations for use of palivizumab for prevention of respiratory syncytial virus infections. | journal=Pediatrics | year= 2009 | volume= 124 | issue= 6 | pages= 1694-701 | pmid=19736258 | doi=10.1542/peds.2009-2345 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19736258  }} </ref>
:::* Note : Significant reduction in Respiratory syncytial virus hospitalization among children with congenital heart disease<ref name="pmid17727335">{{cite journal| author=Feltes TF, Sondheimer HM| title=Palivizumab and the prevention of respiratory syncytial virus illness in pediatric patients with congenital heart disease. | journal=Expert Opin Biol Ther | year= 2007 | volume= 7 | issue= 9 | pages= 1471-80 | pmid=17727335 | doi=10.1517/14712598.7.9.1471 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17727335  }} </ref>


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


[[Category:Viral diseases]]
[[Category:Viral diseases]]
[[Category:Mononegavirales]]
[[Category:Mononegavirales]]
[[Category:Overview complete]]
 
[[Category:Pediatrics]]
[[Category:Pulmonology]]
[[Category:Disease]]


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{{WS}}
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Latest revision as of 18:04, 18 September 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Supportive treatment is the mainstay of therapy for infections caused by human respiratory syncytial virus. Supportive care includes adequate hydration and supplemental oxygen therapy.

Antimicrobial therapy

  • Respiratory syncytial virus treatment
  • Supportive therapy
  • Hydration and supplemental oxygen.
  • Routine use of Ribavirin not recommended. Ribavirin therapy associated with small increases in O2 saturation.
  • No consistent decrease in need for mechanical ventilation or ICU stays. High cost, aerosol administration and potential toxicity[1]
  • Note (1): In adults, Respiratory syncytial virus accounted for 10.6% of hospitalizations for pneumonia, 11.4% for COPD, 7.2% for asthma & 5.4% for CHF in pts >65 yrs of age [2]. Respiratory syncytial virus caused 11% of clinically important respiratory illnesses in military recruits[3]
  • Note (2): Respiratory Syncytial Virus major cause of morbidity in neonates/infants.
  • Note (3): Nucleic acid test now approved to detect 12 respiratory viruses (xTAG Respiratory Viral Panel, Luminex Molecular Diagnostics).
  • Prevention of Respiratory syncytial virus
  • 1. In children <24 months old with chronic lung disease of prematurity (formerly broncho-pulmonary dysplasia) requiring supplemental oxygen or
  • 2. In premature infants (<32 wks gestation) and <6 months old at start of Respiratory syncytial virus season or
  • 3. In children with selected congenital heart diseases.
  • Preferred regimen for prevention of Respiratory syncytial virus: Palivizumab (Synagis) 15 mg per kg IM q month Nov.-April[1]
  • Note : Significant reduction in Respiratory syncytial virus hospitalization among children with congenital heart disease[4]

References

  1. ↑ 1.0 1.1 Committee on Infectious Diseases (2009). "From the American Academy of Pediatrics: Policy statements--Modified recommendations for use of palivizumab for prevention of respiratory syncytial virus infections". Pediatrics. 124 (6): 1694–701. doi:10.1542/peds.2009-2345. PMID 19736258.
  2. ↑ Falsey AR, Hennessey PA, Formica MA, Cox C, Walsh EE (2005). "Respiratory syncytial virus infection in elderly and high-risk adults". N Engl J Med. 352 (17): 1749–59. doi:10.1056/NEJMoa043951. PMID 15858184.
  3. ↑ O'Shea MK, Ryan MA, Hawksworth AW, Alsip BJ, Gray GC (2005). "Symptomatic respiratory syncytial virus infection in previously healthy young adults living in a crowded military environment". Clin Infect Dis. 41 (3): 311–7. doi:10.1086/431591. PMID 16007526.
  4. ↑ Feltes TF, Sondheimer HM (2007). "Palivizumab and the prevention of respiratory syncytial virus illness in pediatric patients with congenital heart disease". Expert Opin Biol Ther. 7 (9): 1471–80. doi:10.1517/14712598.7.9.1471. PMID 17727335.

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