Treatment of Herpangina
The recommended treatment for herpangina is primarily symptomatic, including adequate rehydration, dietary modifications (avoiding salty, spicy, and fried foods), restriction of physical activity, and topical therapy with benzydamine spray for pain relief. 1, 2
Disease Overview
Herpangina is a common infectious disease, primarily affecting children, caused by enteroviruses including:
- Coxsackievirus A (most common)
- Coxsackievirus B
- Enterovirus A
- Echovirus
The condition is characterized by:
- Fever
- Sore throat
- Small vesicular or ulcerative lesions on the soft palate, tonsils, and pharynx
- Typical course of 4-6 days
Treatment Approach
First-line Management
Symptomatic Treatment
- Adequate rehydration to prevent dehydration
- Dietary modifications: exclude salty, spicy, and fried foods
- Restriction of physical activity
- Avoidance of thermal procedures (hot foods/beverages)
Topical Therapy
- Benzydamine spray (such as Oralsept) 0.255 mg/dose, 6 doses 3 times daily as needed for pain relief 1
Antiviral Consideration
- Inosine pranobex (Groprinosin) may be considered at a daily dose of 50 mg/kg of body weight for 7 days 1
- Note: While used in some case reports, antiviral therapy is not universally recommended in guidelines
Supportive Care
- Pain Management: Acetaminophen or NSAIDs for fever and pain control
- Oral Hygiene: Regular mouth rinses with warm saline solution
- Hydration: Encourage fluid intake, preferably cool liquids
Special Considerations
Complications to Monitor
- Dehydration due to painful swallowing
- Secondary bacterial infections
- Rare neurological complications
Prevention Strategies
- Hand washing is highly effective in preventing transmission (OR: 0.00069 [95% CI: 0.0022-0.022]) 3
- Avoid close contact with infected individuals
- Avoid crowded places during outbreaks
Prognosis
The typical course of herpangina lasts 4-6 days with complete resolution of symptoms and excellent prognosis 2. In the documented case study, complete regression of clinical symptoms was observed by day 10 1.
Clinical Pearls
- Diagnosis is primarily clinical based on characteristic pharyngeal lesions
- Virological tests (PCR) can confirm the diagnosis but are not always necessary
- The condition is highly contagious, with outbreaks common in childcare settings
- Risk factors include playing with neighborhood children (OR: 11), visiting outpatient clinics (OR: 20), and exposure to crowded places (OR: 7.3) 3