Treatment for Rhinovirus and Enterovirus Infections
No specific antiviral treatment is recommended for rhinovirus or enterovirus infections; management relies on supportive care and symptomatic treatment. 1, 2
Core Treatment Principles
Supportive Care (First-Line Management)
The mainstay of treatment for both rhinovirus and enterovirus infections is supportive care, as these are predominantly self-limiting viral illnesses 2, 3:
- Adequate hydration to fluidify secretions 2
- Rest to promote recovery 2
- Nasal saline irrigation to relieve congestion and facilitate clearance of secretions 2
- Humidification of the environment to alleviate mucosal dryness 2
- Antipyretics/analgesics (acetaminophen or NSAIDs) for fever and pain relief 2
Why Antibiotics Should NOT Be Used
Antibiotics are completely ineffective for rhinovirus and enterovirus infections and should never be prescribed. 2 The Infectious Diseases Society of America explicitly states that antibiotics are not used for uncomplicated rhinovirus or enterovirus infections as they are ineffective against viruses and contribute to antimicrobial resistance 2. This is a critical pitfall to avoid, as physicians prescribe antibiotics for up to 85-98% of patients with clinically suspected rhinosinusitis, despite most cases being viral 1.
Symptomatic Pharmacological Options
For Rhinovirus Infections
- First-generation antihistamine/decongestant combinations (containing pseudoephedrine and brompheniramine) may help reduce cough and other symptoms 2
- Oral decongestants may provide symptomatic relief, but consider contraindications like hypertension, cardiac arrhythmia, angina, cerebrovascular disease, bladder neck obstruction, glaucoma, or hyperthyroidism 2
- Topical nasal decongestants should be limited to short periods (3-5 days maximum) to avoid rebound congestion (rhinitis medicamentosa) 2
- Newer generation non-sedating antihistamines are relatively ineffective for common cold symptoms 2
Special Populations and Precautions
In children under 3 years, avoid decongestants and antihistamines due to potential adverse effects. 2 The American Academy of Pediatrics specifically recommends against these medications in this age group 2.
Patients with underlying conditions like asthma should be monitored closely, as rhinovirus is a common trigger for exacerbations 2. Rhinovirus infections are major factors in inducing asthma exacerbations in both adults and children 1.
Management of Severe Enterovirus Infections
When to Consider Advanced Interventions
For enterovirus encephalitis or severe CNS disease, the approach differs significantly from uncomplicated infections:
- No specific treatment is recommended for enterovirus encephalitis in most cases 1
- Pleconaril (if available) or intravenous immunoglobulin may be worth considering in patients with severe disease 1, 3
- Pleconaril has broad activity against most enteroviruses and reduced symptoms of aseptic meningitis by approximately two days in phase III trials, though it is not easily available 1
- Intravenous immunoglobulin has been used in patients with chronic enterovirus meningitis and may be useful in severe enterovirus 71 infection, though no randomized trials have been conducted 1
Critical Care Considerations
Patients with falling level of consciousness require urgent assessment by Intensive Care Unit staff for airway protection, ventilatory support, management of raised intracranial pressure, optimization of cerebral perfusion pressure, and correction of electrolyte imbalances 1, 3.
Immunocompromised Patients
Immunocompromised patients may experience prolonged viral shedding and more severe disease. 2 In allogeneic HSCT recipients, rhinoviruses have been identified as the most frequent community-acquired respiratory viruses, with detection rates up to 40% among symptomatic patients 1. Asymptomatic shedding occurs in 13% of HSCT patients, and prolonged shedding over 4 weeks is frequent 1. Lower respiratory tract disease with frank pneumonia is rare (<10% of allogeneic HSCT infected with rhinovirus) but carries an estimated mortality of <10% 1.
For enteroviruses in hematological patients, lymphopenia <500/µL is a risk factor for lower respiratory tract disease in HSCT patients 1.
Infection Control Measures
Standard and contact precautions are essential to prevent transmission in healthcare settings. 2 The Centers for Disease Control and Prevention recommends:
- Hand hygiene is crucial as these viruses spread through direct contact with respiratory secretions 2
- Patient education about covering coughs and sneezes and proper disposal of tissues 2
Common Pitfalls to Avoid
- Do not prescribe antibiotics based on colored nasal discharge alone - sputum color reflects neutrophil presence, not bacterial infection 1
- Do not assume symptoms lasting >7 days indicate bacterial infection - rhinovirus infections commonly last 10-15 days, with symptoms persisting up to 15 days in 7-13% of cases 1
- Do not use prolonged topical decongestants beyond 3-5 days to avoid rebound congestion 2
- Do not expect antihistamines to reduce rhinorrhea in viral infections - evidence shows they are ineffective for this indication 2
Current State of Antiviral Development
The role of specific antiviral treatment is limited by the lack of approved agents and clinical trials 1. While several investigational compounds have shown promise in research settings, including PI4KIIIβ inhibitors and trans-2-hexenoic acid 4, 5, no antiviral agents active against picornaviruses are currently available for clinical use 6.