More treatment options for RSV needed

NEW YORK — Use of alpha or beta agonists is a recommended treatment in the management of respiratory syncytial virus bronchiolitis, according to a presentation at the 23rd Annual Infectious Diseases in Children Symposium.

Paul A. Checchia, MD, associate professor of pediatric critical care and cardiology, St. Louis Children’s Hospital of Washington University, said during a CME seminar supported by MedImmune that the treatment should be discontinued if there is no improvement, and supplemental oxygen should be used if saturation of peripheral oxygen (SpO₂) consistently decreases to less than 90%. This can be discontinued if the SpO₂ increases to more than 90%, if feeding improves or if there is minimal respiratory distress.

“With significant advances in respiratory syncytial virus (RSV) in the last 10 years, current options for RSV treatment are limited and mainly revolve around supportive care,” Checchia said. “Chest physiotherapy, bronchodilators, ribavirin and steroids should not be used routinely in these patients. Antibacterials should be reserved for children with specific indications for the presence of bacterial infections. Their use should be used in the same manner as in children without bronchiolitis.”

Ribavirin is advised against because aerosolized ribavirin therapy for RSV infection is ineffective. It is also a complicated drug to administer and may compromise patient pulmonary function. In addition, it may adversely affect the caregivers, according to Checchia.

Regardless of treatment, physicians are urged to assess fluid status and the ability to take fluids orally. In addition, close monitoring is required for those children with hemodynamically significant heart or lung disease when oxygen is being weaned.

Effective RSV prevention strategies include frequent hand washing and isolation from those with a cold or other illness. Also, avoid second-hand smoke, day care and crowds during the RSV season, if possible. Passive immunoprophylaxis in the form of palivizumab (Synagis, MedImmune) is acceptable for high-risk, premature children, Checchia said.

“Hand decontamination, either with alcohol-based rubs or hand washing with antimicrobial soap, is the most important step in preventing nosocomial spread of RSV,” he said.

Although there is no vaccine available for RSV, palivizumab can be used for immunoprophylaxis in high-risk children. A new humanized RSV monoclonal antibody, called motavizumab, which is derived from palivizumab, is currently being evaluated. In clinical trials, motavizumab demonstrated a 20- to 100-fold increased activity against RSV compared with palivizumab. There was also a 50% reduction in medically attended lower respiratory tract infections with motavizumab, Checchia said.

Disclosure: Dr. Checchia has a direct financial interest in palivizumab. He is a paid consultant for MedImmune.

For more information:

Checchia, PA. Current and Emerging Therapeutics and Immunoprophylaxis for RSV. Presented at: the 23rd Annual Infectious Diseases in Children Symposium; Nov. 20-21, 2010; New York.

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