Isoprinosine for Hand, Foot, and Mouth Disease
Isoprinosine is not effective for hand, foot, and mouth disease and should not be used, as there is no evidence supporting its efficacy and no established antiviral treatment exists for HFMD.
Evidence Base for HFMD Treatment
The provided evidence contains no mention of isoprinosine for hand, foot, and mouth disease. The available guidelines and research consistently emphasize that:
- HFMD has no specific antiviral treatment approved or recommended 1, 2
- The mainstay of management remains supportive care only 3, 2
- Treatment focuses on symptom relief rather than antiviral intervention 1, 4
Standard Management Approach
For Mild Cases (Outpatient Management)
Pain and fever control:
- Use oral acetaminophen or NSAIDs for limited duration to relieve pain and reduce fever 1
- Apply benzydamine hydrochloride oral rinse or spray every 3 hours, particularly before eating, to reduce oral inflammation and pain 1
Oral lesion management:
- Apply white soft paraffin ointment to lips every 2 hours to prevent drying 1
- Use warm saline mouthwashes or oral sponges for comfort 1
- Consider betamethasone sodium phosphate mouthwash (0.5 mg in 10 mL water) as rinse-and-spit solution 1-4 times daily for severe oral involvement 1
Skin care:
- Apply moisturizing creams (particularly urea-containing products) to hands and feet 1
- Use zinc oxide as a protective barrier for itchy skin lesions 1
- Avoid friction and heat exposure to affected areas 1
For Severe Cases Requiring Hospitalization
Recognition of warning signs (particularly in children <3 years with EV-A71 infection and disease duration <3 days) 4:
- Persistent hyperthermia
- Nervous system involvement
- Worsening respiratory rate and rhythm
- Circulatory dysfunction
- Elevated peripheral WBC count, blood glucose, or blood lactic acid 4
Treatment for severe/complicated cases:
- Intravenous immunoglobulin (IVIG) should be considered and has been recommended by several national and international guideline committees 2, 5
- Glucocorticoid therapy may be used as supportive treatment 5
- Intensive monitoring for neurological complications (meningoencephalitis, brainstem encephalitis) and cardiopulmonary complications 6, 5
Important Clinical Pitfalls
Do not confuse HFMD with herpes simplex virus infection, as HSV has available antiviral treatment options whereas HFMD does not 1. This distinction is critical because prescribing antivirals like acyclovir would be inappropriate for HFMD.
Avoid using unproven antiviral agents in routine practice. While drugs such as ribavirin, suramin, and others have emerged as potential candidates in research settings, none are currently approved for HFMD treatment 2.
Infectious Period and Return to Activities
- HFMD is most infectious during the first week of illness, particularly when fever and skin lesions are present 7
- Children can return to daycare/school once fever resolves and mouth sores heal, even if skin rash persists 1
- Hand hygiene with soap and water (more effective than alcohol-based sanitizers) is the most important preventive measure 1, 7
Prevention
An inactivated EV-A71 vaccine approved in China provides high protection against EV-A71-related HFMD, though it does not protect against other causative enteroviruses 6. Vaccination in high-risk areas and good personal hygiene remain the primary preventative measures 2.