What Antibiotics Will Treat RSV? Understanding Viral vs. Bacterial Infections

October 12, 2025 •

4 min read

Each year in the United States, Respiratory Syncytial Virus (RSV) leads to approximately 60,000–160,000 hospitalizations among adults 65 and older [1.8.1]. When it comes to treatment, a common question arises: What antibiotics will treat RSV? The direct answer is that they don't, as antibiotics target bacteria, not viruses like RSV [1.2.3, 1.4.3].

Quick Summary

Antibiotics are not used to treat the viral infection RSV [1.2.2]. Treatment focuses on supportive care to manage symptoms. Antibiotics are only prescribed if a secondary bacterial infection, such as pneumonia or an ear infection, develops [1.3.6].

Key Points

No Antibiotics for RSV: Antibiotics are ineffective against Respiratory Syncytial Virus (RSV) because it is a viral, not a bacterial, infection [1.2.3, 1.4.3].
Supportive Care is Key: The primary treatment for RSV involves managing symptoms through hydration, rest, fever control, and relieving congestion [1.5.1, 1.5.4].
Secondary Infections are the Exception: Antibiotics are only prescribed if a patient with RSV develops a secondary bacterial infection, such as bacterial pneumonia [1.3.6].
Prevention is Advancing: Vaccines are available for older adults and pregnant individuals to prevent severe RSV [1.9.5].
Infant Protection: Monoclonal antibody products like nirsevimab (Beyfortus) and clesrovimab (Enflonsia) are recommended to protect infants from severe RSV disease [1.7.1, 1.7.2].
Hospitalization for Severe Cases: Severe RSV may require hospitalization for oxygen support, IV fluids, and, in rare cases, mechanical ventilation [1.2.4, 1.9.2].
Most Cases are Mild: The majority of RSV infections are mild and resolve on their own within one to two weeks with at-home care [1.2.6].

The Fundamental Misconception: Why Antibiotics Don't Work for RSV

Respiratory Syncytial Virus (RSV) is a common virus that typically causes mild, cold-like symptoms but can be serious, especially for infants and older adults [1.2.6, 1.3.2]. A frequent question from concerned patients and caregivers is, "What antibiotics will treat RSV?" The answer is unequivocally none [1.4.1, 1.4.2]. Antibiotics are powerful medications designed to kill bacteria; they have no effect on viruses [1.2.3]. Using antibiotics unnecessarily for a viral illness like RSV is not only ineffective but can also contribute to antibiotic resistance, a significant public health concern. One study even suggested that using the antibiotic azithromycin during RSV bronchiolitis provided no benefit and could potentially cause harm [1.4.4, 1.4.5].

The Core of RSV Management: Supportive Care

Since there is no specific cure for the RSV infection itself, treatment is centered around managing symptoms and making the patient comfortable until the illness runs its course, which is typically one to two weeks [1.3.2, 1.9.1]. This is known as supportive care.

For mild cases at home, supportive care includes:

Hydration: It is crucial to ensure the patient, especially a child, drinks plenty of fluids to prevent dehydration [1.5.1]. For infants, this means continuing with breast milk or formula. For older individuals, water, soup, or juice can help [1.5.3, 1.5.4].
Fever and Pain Management: Over-the-counter medications like acetaminophen or ibuprofen can be used to manage fever and pain. However, aspirin should never be given to children [1.5.1]. Always consult a healthcare provider before giving a child any non-prescription cold medicine [1.9.1].
Congestion Relief: Using a cool-mist humidifier can help ease congestion and coughing [1.5.4]. Saline nasal drops or sprays, followed by gentle suctioning with a bulb syringe for infants, can also help clear nasal passages [1.5.3, 1.5.6].
Rest: Allowing the body to rest helps it fight off the infection.

For severe cases, hospitalization may be necessary. Hospital-based supportive care may involve:

Intravenous (IV) Fluids: To treat or prevent dehydration if the patient cannot drink enough liquids [1.2.4].
Supplemental Oxygen: Administered through a mask or nasal prongs to help maintain adequate oxygen levels [1.2.1, 1.2.2].
Advanced Airway Support: In very rare and severe instances, mechanical ventilation (a breathing machine) may be required to assist with breathing [1.2.4].
Mucus Suctioning: To clear the airways of excess mucus [1.4.1].

When Are Antibiotics Prescribed During an RSV Illness?

The only time antibiotics are appropriate during an RSV infection is when a patient develops a secondary bacterial infection [1.3.6]. The damage RSV causes to the respiratory tract can sometimes make it easier for bacteria to invade and cause a separate infection. Studies show that influenza and RSV infections can increase the risk for a subsequent Streptococcus pneumoniae infection [1.6.2, 1.6.3].

Common secondary bacterial infections include:

Bacterial Pneumonia [1.5.4]
Middle Ear Infections (Otitis Media)

A healthcare provider must diagnose a concurrent bacterial infection before prescribing antibiotics. The rate of secondary bacterial infection is actually quite low for most infants with RSV [1.6.4]. One study found that in previously healthy infants admitted to the ICU with RSV, bacterial infections of the blood, urine, or cerebrospinal fluid were extremely uncommon [1.6.6].


Treatment Approach	Purpose	Used for RSV?	Notes
Antibiotics	Kills bacteria.	No, unless a secondary bacterial infection is present [1.2.5].	Ineffective against the RSV virus itself [1.2.3].
Supportive Care	Relieves symptoms like fever, congestion, and dehydration.	Yes, this is the primary treatment [1.5.1].	Includes rest, fluids, and over-the-counter pain/fever relievers [1.9.1].
Antivirals	Inhibit viral replication.	Rarely. Ribavirin is the only FDA-approved antiviral but is reserved for very severe cases in immunocompromised patients due to cost and other factors [1.3.3].	Not routinely recommended for most patients [1.9.1].
Monoclonal Antibodies	Provide passive immunity to prevent severe disease.	For prevention, not treatment [1.3.4, 1.7.5].	Nirsevimab (Beyfortus) and Clesrovimab (Enflonsia) are for infants; Palivizumab is for certain high-risk infants [1.7.1, 1.7.2].

Modern Prevention: A Proactive Approach

Significant advancements have been made in preventing severe RSV disease, reducing the need for treatment in the first place. These preventative measures do not treat an active infection but provide passive immunity.

For Infants and Young Children:

Monoclonal Antibodies: These are not vaccines but are ready-made antibodies delivered via injection to protect against severe RSV. The CDC recommends either a maternal RSV vaccine during pregnancy or an infant monoclonal antibody shot [1.9.5]. Options for infants include nirsevimab (Beyfortus) and, as of June 2025, clesrovimab (Enflonsia) [1.7.1, 1.7.2]. Palivizumab is another option given in a series of shots for certain high-risk babies [1.2.1].
Maternal RSV Vaccine: The CDC recommends the Pfizer vaccine Abrysvo for pregnant individuals between 32 and 36 weeks of gestation to pass protective antibodies to the baby before birth [1.3.5].

For Older Adults:

RSV Vaccines: The CDC recommends a single dose of an RSV vaccine for adults aged 75 and older, and for adults 50-74 who are at increased risk of severe disease [1.9.4, 1.9.5]. Available vaccines include Arexvy, Abrysvo, and mResvia [1.7.2].

Conclusion

To reiterate, antibiotics do not treat RSV because it is a virus. The foundation of managing an RSV infection is supportive care to alleviate symptoms. Antibiotics are reserved only for the specific cases where a secondary bacterial infection has been confirmed by a doctor [1.3.3, 1.3.6]. With the advent of effective vaccines for older adults and pregnant people, and monoclonal antibodies for infants, the focus is shifting towards prevention as the most powerful tool against severe RSV disease [1.9.5].

For more information on RSV prevention and care, you can visit the Centers for Disease Control and Prevention (CDC) page on RSV.

Frequently Asked Questions

No, antibiotics do not work on the RSV virus and will not treat the cough associated with it. The mainstay of treatment is supportive care, such as using a cool-mist humidifier and ensuring your child stays hydrated [1.5.4, 1.9.1].

Doctors do not prescribe antibiotics for RSV because it's a viral infection [1.4.3]. Antibiotics only treat bacterial infections. Using them for viruses is ineffective and contributes to antibiotic resistance.

A person with RSV would only be prescribed antibiotics if they develop a secondary bacterial infection, such as bacterial pneumonia or a bacterial ear infection, which must be diagnosed by a healthcare provider [1.3.6, 1.5.4].

There is no specific treatment for most RSV infections; care is supportive [1.2.6]. An antiviral medication, ribavirin, is approved but is rarely used and only for the most severe cases in high-risk, immunocompromised patients [1.3.3].

The best way to treat mild RSV at home is with supportive care: manage fever and pain with over-the-counter medications like acetaminophen, ensure adequate fluid intake, use a humidifier, and clear nasal congestion with saline drops [1.5.1, 1.5.4].

To protect infants, the CDC recommends either the mother receives an RSV vaccine during pregnancy (32-36 weeks) or the baby receives a monoclonal antibody shot (like nirsevimab or clesrovimab) soon after birth [1.3.5, 1.9.5].

It's possible. While RSV itself can become severe, worsening symptoms or the development of new ones could indicate a secondary bacterial infection. You should contact a healthcare provider for an evaluation if you are concerned [1.3.1].