Human respiratory syncytial virus medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
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. Treatment is otherwise supportive care only with fluids and oxygen until the illness runs its course.
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
- ↑ 1.0 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.