Purpose of Review <p>Respiratory syncytial virus (RSV) is a frequent seasonal respiratory virus that can cause severe disease in children, elderly and those with immunocompromising conditions. RSV disease can be particularly severe in hematopoietic stem cell transplant recipients, hematologic malignancy patients and lung transplant recipients. This review explores the role of ribavirin in the management of RSV infections in these high-risk groups, summarizing historical and recent evidence to guide clinical practice.</p> Recent Findings <p>Ribavirin has been used off-label for RSV treatment in immunocompromised patients for decades, mostly based on observational data. Aerosolized ribavirin, once the standard of care, has since been replaced by oral ribavirin due to ease of administration, comparable efficacy and cost. More recent meta-analyses suggest ribavirin use may reduce mortality in hematologic malignancy and hematopoietic stem cell recipients, though data in lung transplant recipients remains uncertain. The combination of ribavirin and intravenous immunoglobulin is commonly utilized to prevent progression of upper respiratory tract infection to lower respiratory tract infections. Robust randomized trial data remain lacking.</p> Summary <p>Ribavirin continues to remain an important therapeutic option for vulnerable immunocompromised patients, mainly to prevent progression of disease to lower respiratory tract infections and reduce mortality. While newer agents remain under investigation, the current evidence supports use of oral or aerosolized ribavirin in high-risk populations, often in combination with intravenous immunoglobulin. Future studies are needed to refine treatment strategies in these patients.</p>