title: Lower respiratory tract infection caused by respiratory syncytial virus: current management and new therapeutics.
abstract: Respiratory syncytial virus (RSV) is a major worldwide cause of morbidity and mortality in children under five years of age. Evidence-based management guidelines suggest that there is no effective treatment for RSV lower respiratory tract infection (LRTI) and that supportive care, ie, hydration and oxygenation, remains the cornerstone of clinical management. However, RSV treatments in development in the past decade include 10 vaccines and 11 therapeutic agents in active clinical trials. Maternal vaccination is particularly relevant because the most severe disease occurs within the first 6 months of life, when children are unlikely to benefit from active immunisation. We must optimise the implementation of novel RSV therapeutics by understanding the target populations, showing safety, and striving for acceptable pricing in the context of this worldwide health problem. In this Review, we outline the limitations of RSV LRTI management, the drugs in development, and the remaining challenges related to study design, regulatory approval, and implementation.
authors.affiliation: Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Natalie I
authors.initials: NI
authors.lastname: Mazur
authors.affiliation: Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hóspital Clínico Universitario de Santiago de Compostela, University of Santiago, La Coruña, Padova, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Martinón-Torres
authors.affiliation: Women's and Children's Health Department, Unit of Respiratory Medicine and Allergy, Padova, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Baraldi
authors.affiliation: Noninvasive ventilation and Sleep Unit, Necker Pediatric University Hospital, Paris Descartes University, Paris, France.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Fauroux
authors.affiliation: Division of Asthma, Allergy and Lung Biology, King's College, London, UK.
authors.forename: Anne
authors.initials: A
authors.lastname: Greenough
authors.affiliation: Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland.
authors.forename: Terho
authors.initials: T
authors.lastname: Heikkinen
authors.affiliation: Neonataology and Neonatal Intensive Care Unit, S Anna Hospital, Torino, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Manzoni
authors.affiliation: Pediatric Infectious Diseases, Nationwide Children's Hospital, and The Ohio State University, Columbus, Ohio, United States of America.
authors.forename: Asuncion
authors.initials: A
authors.lastname: Mejias
authors.affiliation: Center for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh Medical School, Edinburgh, UK.
authors.forename: Harish
authors.initials: H
authors.lastname: Nair
authors.affiliation: University of Manchester, Manchester, UK; Allergy Dept 2nd Pediatric Clinic, University of Athens, Athens, Greece.
authors.forename: Nikolaos G
authors.initials: NG
authors.lastname: Papadopoulos
authors.affiliation: Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: Fernando P
authors.initials: FP
authors.lastname: Polack
authors.affiliation: Pediatric Infectious Diseases, Nationwide Children's Hospital, and The Ohio State University, Columbus, Ohio, United States of America.
authors.forename: Octavio
authors.initials: O
authors.lastname: Ramilo
authors.affiliation: Pediatric Infectious Diseases Research Group, St George's University London, UK.
authors.forename: Mike
authors.initials: M
authors.lastname: Sharland
authors.affiliation: Pediatric Pulmonology Unit, Pontifícia Universidade Católica RS, Porto Alegre, Brazil; Hospital for Sick Children, Toronto, Canada.
authors.forename: Renato
authors.initials: R
authors.lastname: Stein
authors.affiliation: Department of Science and Technology/ National Research Foundation: Vaccine Preventable Diseases, University of Witwatersrand, Johannesburg, South Africa; Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of Witwatersrand, Johannesburg, South Africa.
authors.forename: Shabir A
authors.initials: SA
authors.lastname: Madhi
authors.affiliation: Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands. Electronic address: l.bont@umcutrecht.nl.
authors.forename: Louis
authors.initials: L
authors.lastname: Bont
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D002675:Child, Preschool; D019468:Disease Management; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D018357:Respiratory Syncytial Virus Infections / Q000188:drug therapy* / Q000821:virology; D012136:Respiratory Syncytial Viruses; D012141:Respiratory Tract Infections / Q000188:drug therapy* / Q000821:virology; D014611:Vaccination
chemical_list: D000998:Antiviral Agents