From the Guidelines
Treatment of Coxsackie virus infection is primarily supportive, focusing on relieving symptoms while the body's immune system fights the infection, as there is no specific antiviral therapy approved for this condition. The management of Coxsackie virus infection involves relieving symptoms such as pain and fever, which can be achieved with acetaminophen (10-15 mg/kg every 4-6 hours, maximum 75 mg/kg/day in children or 3000 mg/day in adults) or ibuprofen (10 mg/kg every 6-8 hours in children or 400-600 mg every 6-8 hours in adults) 1. Some key considerations in the treatment of Coxsackie virus infection include:
- Adequate hydration, especially if fever or mouth sores are present, by drinking clear fluids regularly and avoiding acidic or spicy foods that may irritate mouth ulcers
- Use of topical oral anesthetics like viscous lidocaine to manage mouth pain in cases of hand, foot, and mouth disease
- Hospitalization for monitoring and supportive care in severe cases with complications like myocarditis or meningitis
- Preventive measures such as regular handwashing, avoiding close contact with infected individuals, and disinfecting commonly touched surfaces to reduce the spread of the virus through respiratory droplets and fecal-oral routes. It is essential to note that most Coxsackie infections are self-limiting and resolve within 7-10 days as the virus is eliminated by the body's natural immune response 1.
From the Research
Treatment Options for Coxsackievirus Infection
- The treatment options for Coxsackievirus infection are varied and depend on the severity of the infection 2, 3, 4, 5, 6.
- For viral myocarditis caused by Coxsackievirus B, treatment strategies include immunosuppressive agents, intravenous immunoglobulin (IVIG), antiviral agents, and natural products 2.
- Immunosuppressive agents such as azathioprine, prednisone, and cyclosporine may be used to treat myocarditis, as they can suppress the immune response 2.
- IVIG has been shown to be effective in treating viral myocarditis, as it can suppress the immune response, replace antibodies, enhance viral clearance, and neutralize pathogens 2, 4.
- Antiviral agents such as interferons, pleconaril, and acyclovir may be used to target the causative organism and halt the cascade of myocyte destruction 2, 3.
- Natural products such as Astragalus membranaceus and Ardisia chinensis have been proposed as potential treatments for viral myocarditis 2.
- In severe cases of Coxsackie virus B infection, pleconaril has been shown to be effective in treating preterm newborns 3.
- Soluble coxsackie- and adenovirus receptor (sCAR-Fc) has been found to have high antiviral activity against laboratory and clinical strains of Coxsackie-B-virus 6.
- Reaferon has been established to be effective in complex treatment of meningitis caused by Coxsackie virus B, shortening the period of fever and driving away main clinical symptoms 5.
Specific Treatment Approaches
- For neonates with enteroviral infections, high-dose IVIG treatment may be considered, especially if myocarditis develops despite initial IVIG treatment 4.
- For patients with dilated cardiomyopathy, agents commonly used in heart failure may be beneficial, as their symptoms and presentation are similar 2.
- Symptomatic treatment is currently the main approach for treating Coxsackie-B-virus infection, due to the lack of specific antiviral therapy 6.