Treatment of Herpangina
Herpangina is a self-limited viral illness requiring only supportive care, as it resolves spontaneously within 4-6 days without specific antiviral therapy. 1
Understanding the Disease
Herpangina is an acute enteroviral infection (primarily Coxsackievirus A, Enterovirus A, and Echovirus) that predominantly affects young children with an average age of onset around 2.5 years. 2, 1 This is fundamentally different from herpes simplex virus infections—the guidelines about HSV treatment provided in the evidence are not applicable to herpangina despite the similar-sounding name.
Primary Treatment Approach: Supportive Care
The mainstay of treatment is symptomatic management, not antiviral therapy. 1
Essential supportive measures include:
- Adequate hydration to prevent dehydration from reduced oral intake 3
- Dietary modifications: exclude salty, spicy, and fried foods that irritate oral lesions 3
- Restriction of physical activity during the acute phase 3
- Avoidance of thermal procedures 3
- Antipyretics and analgesics for fever and pain management 1
Topical Therapy Options
While the disease is self-limited, topical agents may provide symptomatic relief:
- Benzydamine spray (0.255 mg/dose): 6 doses 3 times daily, applied topically on demand for local pain relief 3
- Interferon α-2b spray: In a randomized controlled trial of 668 children, this showed superior efficacy compared to ribavirin, with 98.5% of patients achieving fever resolution within 72 hours versus 94.3% in the control group (P = 0.004), and better oral lesion improvement (46.7% vs 37.1%, P = 0.011) with no adverse reactions 2
Antiviral Considerations
- Inosine pranobex (Groprinosin): One case report used 50 mg/kg/day (1 tablet per 10 kg body weight) for 7 days with complete symptom resolution by day 10 3
- However, Chinese expert consensus emphasizes that treatment is mainly symptomatic and topical, not systemic antiviral therapy 1
Expected Clinical Course
- Oral lesions typically resolve within 7 days or less 4
- The overall disease course is 4-6 days with good prognosis 1
- Complete regression of symptoms should occur by day 10 3
Prevention Strategies
- Hand-washing is highly protective: Children with good hand-washing scores (≥7 on a 4-question assessment) had dramatically lower infection rates (OR: 0.00069,95% CI: 0.0022-0.022) 5
- Avoid crowded places and contact with infected children during outbreaks, as these are significant risk factors (OR: 7.3-11) 5
Critical Pitfall to Avoid
Do not confuse herpangina with herpes simplex virus infections. Despite the name similarity, herpangina is caused by enteroviruses (Coxsackie, ECHO), not herpes viruses, and does not respond to acyclovir or other anti-HSV medications. 4, 1 The characteristic finding is vesicular lesions in the posterior pharynx (soft palate, uvula, tonsillar pillars), not the anterior mouth as seen in HSV stomatitis.