Treatment of Hand, Foot, and Mouth Disease
Hand, foot, and mouth disease treatment is primarily supportive, focusing on pain relief and hydration, as the disease is self-limiting and resolves in 7-10 days without specific antiviral therapy in most cases 1, 2.
Mild Cases (Majority of Patients)
Most cases can be managed as outpatients with symptomatic treatment only 3. The treatment approach includes:
Pain Management
- Acetaminophen or ibuprofen for fever and pain control 2
- Oral lidocaine is NOT recommended 2
- For oral pain, focus on maintaining hydration despite discomfort
Hydration
- Ensure adequate fluid intake, as painful oral ulcerations may reduce oral intake
- This is the primary concern in mild cases
Isolation
- Isolate patients to prevent cross-infection 3
- Best prevention methods are handwashing and disinfecting contaminated surfaces 2
Severe/Complicated Cases
For severe cases with neurologic or cardiopulmonary complications, consider intravenous immunoglobulin (IVIG) 1. The Chinese guidelines 3 recommend IVIG for severe cases, though this differs from WHO/US-CDC recommendations.
Warning Signs Requiring Escalation of Care
Watch for these indicators of deterioration 3:
- Persistent high fever
- Nervous system involvement
- Worsening respiratory rate/rhythm
- Circulatory dysfunction
- Elevated peripheral WBC count
- Elevated blood glucose
- Elevated blood lactate
Critical Recognition Points
Pay particular attention to 3:
- Children under 3 years old
- EV-A71 infections (more severe than coxsackievirus A16)
- Disease duration less than 3 days
- These patients require close monitoring for progression to severe disease
Antiviral Therapy
Currently, no specific antiviral agents are approved for HFMD treatment 1, 2. However:
- One case report showed dramatic improvement with valacyclovir in an adult patient (resolution within 48 hours) 4, though this is off-label use requiring further validation
- Drugs under investigation include ribavirin, suramin, mulberroside C, and sertraline 1
Traditional Chinese Medicine
The Chinese guidelines differ from Western recommendations by including traditional Chinese herbs (TCH). Lan-Qin showed higher recovery rates in mild cases in one retrospective study 5, though this requires validation in randomized trials.
Common Pitfalls to Avoid
- Do not use oral lidocaine - it is not recommended despite oral pain 2
- Do not prescribe antibiotics - HFMD is viral; antibiotics have no role unless secondary bacterial infection occurs
- Do not dismiss cases in adults - while 95% occur in children under 5, adults can be affected 6
- Do not miss the narrow window for intervention in severe cases - stages 2 and 3 are critical for preventing progression to stage 4 (cardiopulmonary failure) 3
Key Complications to Monitor
The main causes of death are 1:
- Circulatory failure from myocardial impairment
- Neurogenic pulmonary edema from brainstem damage
Fortunately, 99.8% of cases recover 5, and the disease typically resolves in 7-10 days without sequelae 1, 2.
Prevention
Vaccination with inactivated EV-A71 vaccines (available in China) shows over 90% efficacy in preventing severe HFMD 7. Other preventive measures include hand hygiene, breastfeeding, and environmental sanitation 7.