Inosine for Hand, Foot, and Mouth Disease (HFMD)
There is no evidence supporting the use of inosine for treating pediatric patients with HFMD, and it should not be used for this indication.
Evidence Base for HFMD Treatment
The provided evidence contains no guidelines, drug labels, or research studies addressing inosine use in HFMD. The available literature focuses on:
Supportive care remains the cornerstone of HFMD management, as there is no specific pharmaceutical intervention currently approved for this viral illness 1, 2.
Chinese guidelines for HFMD (2018) emphasize early recognition of severe cases and stratification into disease stages, with treatment focused on preventing progression to critical illness (stage 4) 2.
Key warning signs requiring intensive monitoring include: persistent hyperthermia, nervous system involvement, worsening respiratory rate and rhythm, circulatory dysfunction, elevated peripheral WBC count, elevated blood glucose, and elevated blood lactic acid 2.
Evidence-Based Treatment Approaches
Mild Cases
- Most mild HFMD cases can be managed as outpatients with isolation to prevent cross-infection 2.
- Symptomatic treatment addresses fever, oral pain, and skin lesions 1, 2.
Severe Cases with Neurological Complications
- Intravenous immunoglobulin (IVIG) and glucocorticoid therapies represent the common supportive treatments for severe neurological complications including meningoencephalitis and brainstem encephalitis 3.
- Intensive treatment modalities should be initiated immediately for severe cases to prevent mortality 2.
Emerging Treatment Option
- EPs® 7630 (Pelargonium sidoides extract) showed significant reduction in disease duration [6.07 vs 8.58 days, p<0.001] and lower hospitalization rates in a 2024 randomized controlled trial of 208 children with HFMD 4. This represents the most recent evidence for a specific treatment intervention, though it requires further validation.
Prevention
- An inactivated Enterovirus A71 (EV-A71) vaccine approved by China's CFDA provides high-level protection against EV-A71-related HFMD, though it does not cover all causative pathogens 1.
Critical Clinical Pitfalls
Do not delay recognition of severe disease: Children under 3 years with EV-A71 infection and disease duration less than 3 days require particularly close monitoring 2.
Do not use unproven therapies like inosine: Without any evidence base, such interventions may delay appropriate supportive care and monitoring for severe complications 1, 2.
Monitor for rapid deterioration: Severe HFMD can progress quickly to cardiopulmonary complications and fatal outcomes, particularly with meningoencephalitis and brainstem encephalitis accounting for 70% of neurological complications 5, 3.