What happens if I give antibiotics to someone with hand-foot-mouth disease or viral pharyngitis?

Antibiotics for Hand-Foot-Mouth Disease and Viral Pharyngitis

Antibiotics should NOT be given for hand-foot-mouth disease or viral pharyngitis as they are ineffective against viral infections and may lead to unnecessary side effects and antimicrobial resistance. 1

Hand-Foot-Mouth Disease (HFMD)

HFMD is a highly contagious viral illness caused by enteroviruses, primarily:

• Coxsackieviruses A6, A10, A16 2
• Enterovirus 71 2, 3

Clinical Course and Management:

• Self-limiting disease that typically resolves within a few days without complications 4
• Characterized by fever, oral vesicular lesions, and rashes on hands, feet, and sometimes buttocks 2
• Treatment is symptomatic and supportive only 2
• No specific antiviral therapy is generally recommended 2, 4

Key Points:

• Antibiotics have no role in the management of HFMD as they are ineffective against viral pathogens 2
• For symptom relief, appropriate options include:
  • Acetaminophen or NSAIDs for fever and pain 1
  • Oral analgesics and hydration for comfort 2

Viral Pharyngitis

Diagnostic Considerations:

• Most cases of pharyngitis (up to 90% in adults) are viral in origin 1
• Features suggesting viral etiology include:
  • Cough, conjunctivitis, rhinorrhea, hoarseness 5
  • Absence of fever, tonsillar exudates, and cervical adenopathy 1

Management Approach:

• Antibiotics should NOT be prescribed for viral pharyngitis 1
• Treatment should focus on symptomatic relief:
  • Analgesics such as acetaminophen or NSAIDs 1
  • Throat lozenges for local pain relief 1
  • Salt water gargles or topical anesthetics may provide comfort 1

Patient Education:

• Inform patients that viral pharyngitis typically resolves within one week 1
• Explain that antibiotics do not shorten the duration of viral illness and may cause adverse effects 1

When Antibiotics ARE Appropriate

Antibiotics should only be considered when there is evidence of bacterial infection:

Group A Streptococcal (GAS) Pharyngitis:

• Test patients with symptoms suggestive of GAS (persistent fever, cervical adenitis, tonsillar exudates) using rapid antigen detection test (RADT) and/or culture 1
• Treat ONLY if GAS is confirmed by laboratory testing 1
• Benefits of antibiotics in confirmed GAS pharyngitis:
  • Modest reduction in symptom duration (by 1-2 days) 1
  • Prevention of complications such as acute rheumatic fever and peritonsillar abscess 1

Potential Harms of Inappropriate Antibiotic Use

• Contributes to antimicrobial resistance 5
• Risk of adverse drug reactions 1
• Disruption of normal gut microbiota 1
• False sense of security that may delay appropriate care 1
• Unnecessary healthcare costs 1

Common Pitfalls to Avoid

• Treating without confirming bacterial etiology through appropriate testing 5
• Prescribing antibiotics based solely on clinical appearance without laboratory confirmation 1
• Failing to distinguish between viral and bacterial causes of pharyngitis 1
• Yielding to patient pressure for antibiotics when not indicated 1

Remember that most respiratory infections, including HFMD and viral pharyngitis, are self-limiting and resolve without specific antimicrobial therapy. Focus on symptomatic relief and patient education about the viral nature of these conditions 1, 2.