Isoprinosine Has No Established Role in HFMD Management
There is no guideline or high-quality evidence supporting the use of Isoprinosine (Inosine Pranobex) for Hand, Foot, and Mouth Disease (HFMD) in pediatric patients. The provided evidence contains no mention of this medication for HFMD, and current treatment guidelines focus exclusively on supportive care with specific interventions reserved for severe/complicated cases.
Standard Treatment Approach for HFMD
Mild Disease (Majority of Cases)
- Supportive care is the mainstay of treatment, as HFMD is self-limited and resolves in 7-10 days without sequelae in most cases 1, 2.
- Symptomatic management includes pain control, hydration, and monitoring for complications 1, 3.
- Most mild cases can be treated as outpatients with isolation to avoid cross-infection 3.
Severe/Complicated Disease Requiring Escalation
- Intravenous immunoglobulin (IVIG) should be considered for severe/complicated HFMD and has been recommended by several national and international guideline committees 1.
- Glucocorticoid therapy is commonly used in combination with IVIG for severe neurological complications 4.
Early Recognition of Severe Disease is Critical
The Chinese guidelines emphasize that timely recognition of stages 2 and 3 HFMD prevents progression to stage 4 (critical disease) 3. Clinicians must monitor for these warning signs:
- Persistent hyperthermia 3
- Nervous system involvement (meningoencephalitis, brainstem encephalitis account for 70% of neurological complications) 3, 4
- Worsening respiratory rate and rhythm 3
- Circulatory dysfunction 3
- Elevated peripheral WBC count, blood glucose, or blood lactic acid 3
High-Risk Populations Requiring Closer Monitoring
- Children under 3 years of age with EV-A71 infection 3
- Disease duration less than 3 days 3
- EV-A71 genotype C (especially C4a) is associated with severe complications 4
Why No Antiviral Agents Are Currently Approved
There are no specific antiviral agents approved for HFMD treatment 1. While drugs such as ribavirin, suramin, mulberroside C, aminothiazole analogs, and sertraline have emerged as potential candidates, none have achieved regulatory approval or guideline recommendation 1.
Critical Pitfalls to Avoid
- Do not delay recognition of severe disease by focusing on unproven therapies—circulatory failure from myocardial impairment and neurogenic pulmonary edema from brainstem damage are the main causes of death 1.
- Do not confuse atypical HFMD presentations (such as "eczema coxsackium" in children with atopic dermatitis) with herpes simplex infection, as this may lead to inappropriate antiviral therapy 2.
- Do not overlook EV-A71 cases, which are more severe with higher complication rates than coxsackievirus A16 1.