Palivizumab

How it works

It is a humanised monoclonal antibody directed against an epitope on the RSV fusion (F) protein, neutralising the virus and inhibiting its fusion with and entry into respiratory epithelial cells.

Prescribing in practice

• Reserve for defined high-risk groups (such as certain preterm infants and those with chronic lung disease or haemodynamically significant congenital heart disease), as it is not for routine use in healthy infants.
• Protection is short-lived, requiring repeated monthly injections through the RSV season to maintain antibody levels.
• Administer according to the SPC and national eligibility criteria; hypersensitivity reactions can occur and require appropriate precautions.

Monitoring

Observe for hypersensitivity and injection-site reactions after each dose; no routine laboratory monitoring is required.

Counselling the patient

• Explain that monthly injections through the winter season are needed to keep the baby protected against severe RSV infection.
• It does not prevent all RSV infection and is reserved for babies at highest risk.
• Report any signs of an allergic reaction, and keep to the schedule of repeat doses.

Evidence & guidelines

The IMpact-RSV trial established that palivizumab reduces RSV-related hospitalisation in high-risk infants, and NICE guidance defines the eligible high-risk groups for prophylaxis.