Respiratory syncytial virus infection in immunocompromised patients, especially those with defects in cell mediated immunity is associated with high morbidity and mortality. Lymphocytopenia is an important factor associated with progression of upper to lower respiratory tract infection. The only licensed antiviral treatment for RSV available currently is ribavirin, although additional immunomodulatory therapies may also play a beneficial role. The use of ribavirin in immunocompromised patients with lower respiratory tract infection has some evidence for efficacy in reducing mortality. We report two cases of pre-transplant patients with acute myeloid leukaemia who were considered for ribavirin treatment for RSV upper respiratory tract infection and review the published literature on this. The use of ribavirin in immunocompromised patients with RSV upper respiratory tract infection to reduce the risk of progression to lower respiratory tract infection is unclear. In patients with Respiratory syncytial virus upper respiratory tract infection detected in the pre-haematopoetic stem cell transplant stage, delay of transplantation remains the most effective method of reducing morbidity and mortality.

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