What is the primary approach to treating human rhinovirus (HRV) and enterovirus (EV) infections?

Treatment of Human Rhinovirus and Enterovirus Infections

Primary Treatment Approach

The treatment of human rhinovirus (HRV) and enterovirus (EV) infections is exclusively supportive and symptomatic, as there are no approved antiviral therapies for these pathogens. 1, 2, 3

Core Supportive Measures

The foundation of management consists of non-pharmacological interventions that directly address symptoms and promote recovery:

• Adequate hydration to fluidify respiratory secretions and facilitate clearance 1, 4
• Nasal saline irrigation to relieve congestion and mechanically clear nasal secretions 1, 4
• Rest to support the immune response and recovery 1, 4
• Environmental humidification to alleviate mucosal dryness and improve comfort 1, 4

Pharmacological Symptomatic Treatment

First-Line Agents

• Acetaminophen or NSAIDs (ibuprofen) for fever and pain relief, which addresses the primary reason patients seek medical care 1, 4

Additional Symptomatic Options

• First-generation antihistamine/decongestant combinations (containing sustained-release pseudoephedrine and brompheniramine) have demonstrated efficacy in reducing cough and other symptoms 1, 4
• Oral decongestants may provide symptomatic relief, but must be avoided in patients with hypertension or anxiety 1, 4
• Topical intranasal corticosteroids may offer modest symptom relief 4
• Topical nasal decongestants can be used for severe congestion but must be strictly limited to 3-5 days to prevent rebound congestion (rhinitis medicamentosa) 1, 4

Agents with Limited or No Efficacy

• Newer generation non-sedating antihistamines are relatively ineffective for common cold symptoms and should not be routinely recommended 1, 4
• Guaifenesin and dextromethorphan lack robust evidence of clinical efficacy 4

What NOT to Do

Antibiotics must never be prescribed for uncomplicated rhinovirus or enterovirus infections. 1, 4 They are completely ineffective against viral pathogens, expose patients to unnecessary adverse effects, and contribute to antimicrobial resistance. 1, 4

The only exception is when clear evidence of bacterial superinfection exists: symptoms persisting beyond 10 days without improvement, or "double worsening" (initial improvement followed by deterioration within 10 days). 4

Special Population Considerations

Pediatric Patients

• Avoid decongestants and antihistamines in children under 3 years due to potential adverse effects without proven benefit 1, 4

Immunocompromised Patients

• These patients may experience prolonged viral shedding (potentially years in stool), more severe disease manifestations, and require closer monitoring 5, 1, 6
• Maintain a low threshold for investigation in immunocompromised hosts, particularly those on IgG-depleting therapies like rituximab 5, 6

Patients with Underlying Respiratory Disease

• Monitor closely patients with asthma or COPD, as rhinovirus is a common trigger for acute exacerbations 1, 4

Infection Control

To prevent transmission in healthcare and community settings:

• Standard and contact precautions in healthcare facilities 1
• Rigorous hand hygiene, as these viruses spread through direct contact with respiratory secretions 1
• Patient education on covering coughs/sneezes and proper tissue disposal 1

Critical Pitfalls to Avoid

• Do not prescribe antibiotics based on colored nasal discharge—sputum color reflects neutrophil presence, not bacterial infection 4
• Do not use prolonged topical decongestants beyond 3-5 days 1, 4
• Do not underutilize simple measures like saline irrigation and hydration, which provide significant relief without adverse effects 4
• Do not interpret positive stool or throat specimens as definitive proof of causation, as these viruses colonize the gut and throat for weeks to months after acute infection 5, 6

Diagnostic Considerations When Needed

If diagnostic confirmation is required (severe disease, outbreak investigation, surveillance):

• RT-PCR targeting the 5′non-coding region is the diagnostic method of choice due to superior sensitivity and specificity 5, 1, 6
• Collect multiple specimen types: respiratory specimens (especially critical for EV-D68), stool, CSF, and blood as clinically indicated 5, 1, 6
• Avoid virus isolation for routine diagnosis and serological methods (ELISA, neutralization tests), as they lack sensitivity and clinical utility for acute infection 5, 1, 6