caa a22 4500 47578426X CHVBK 20180406123653.0 cr unu---uuuuu 170329e20000501xx s 000 0 eng 10.1007/s004310051295 doi (NATIONALLICENCE)springer-10.1007/s004310051295 Therapy for respiratory tract infections caused by respiratory syncytial virus [Elektronische Daten] [Job van Woensel, Jan Kimpen] Respiratory syncytial virus (RSV) is the most common viral cause of lower respiratory tract infection (LRTI) in infancy and young children. No effective treatment for RSV lower respiratory tract infection (RSV-LRTI) exists. Ribavirin initially proved to be an effective anti-viral drug for RSV-LTRI. However, subsequently performed trials could not reproduce these positive results and, based on the current available evidence, there is no place for ribavirin in the routine treatment of RSV-LTRI. The use of nebulised bronchodilator therapy in RSV-LTRI has been subject of many trials, with conflicting results. Although the individual patient may have some short-term benefit from nebulised bronchodilators, there does not seem to be a sufficient scientific basis for the standard use of bronchodilator therapy in infants and children with RSV-LTRI. There is increasing evidence that RSV-LTRI is an immune-mediated disease and therefore corticosteroids may be an effective treatment. The results from efficacy trials have demonstrated that corticosteroids are not effective for patients with mild RSV infection. In contrast there are indications that it may be beneficial in patients with more severe RSV-LTRI. It has been demonstrated that in children with RSV infection the vitamin A concentration is inversely related to disease severity. The use of vitamin A in the treatment of patients with RSV-LTRI, however, proved not to be effective. Immunoprophylaxis with hyperimmune immunoglobulins and monoclonal antibody against the viral F-protein have been shown to be effective in the prevention of RSV-LRTI. From the results of the therapeutic efficacy trials, however, it can be discerned that immunoglobulins have no place in the treatment of RSV-LRTI. Conclusion Although respiratory syncytial virus infections each year have a considerable socioeconomic impact, attempts to find an effective therapy have so far been quite unsuccessful. Anti-viral therapy with ribavirin has not been proven to be effective. Symptomatic therapy with bronchodilators may give only short-term relief of symptoms in some individual patients, but has no effect on hospitalisation rates, or duration of hospitalisation. The beneficial effect of corticosteroids in patients with mild respiratory syncytial virus infection is very disappointing, however, there are indications that there might be an effect in patients with more severe infection. So far no beneficial therapeutic effect has been demonstrated with immune globulins. Springer-Verlag Berlin Heidelberg, 2000 Key words Respiratory syncytial virus nationallicence Respiratory tract infection nationallicence Treatment nationallicence Review nationallicence AbbreviationsFI-RSV formalin inactivated respiratory syncytial virus nationallicence IVIG standard intravenous immune globulin nationallicence LRTI lower respiratory tract infection nationallicence RSV respiratory syncytial virus nationallicence RSVIG hyperimmune RSV globulins nationallicence RSV-LRTI respiratory syncytial virus lower respiratory tract infection nationallicence van Woensel Job Paediatric Intensive Care Unit/G8ZW, Emma Children's Hospital, Academic Medical Centre, Meibergdreef 9, PO Box 22660, 1100 DD Amsterdam, The Netherlands e-mail: j.b.vanwoensel@amc.uva.nl, NL aut Kimpen Jan Wilhelmina Children's Hospital, University Medical Centre, Utrecht, The Netherlands, NL aut https://doi.org/10.1007/s004310051295 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s004310051295 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- van Woensel Job Paediatric Intensive Care Unit/G8ZW, Emma Children's Hospital, Academic Medical Centre, Meibergdreef 9, PO Box 22660, 1100 DD Amsterdam, The Netherlands e-mail: j.b.vanwoensel@amc.uva.nl, NL aut NATIONALLICENCE 700 1- Kimpen Jan Wilhelmina Children's Hospital, University Medical Centre, Utrecht, The Netherlands, NL aut Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer