Pharyngoconjunctival Fever Treatment & Management

• Because PCF usually is a self-limited disease, treatment is mainly symptomatic, as follows:

  • Cold compresses several times per day for 1-2 weeks
  • Artificial tears 4-8 times per day for 1-3 weeks
• The following drugs may be used but rarely are indicated:

  • A topical vasoconstrictor/antihistamine may be instilled 4 times per day for severe itching only, because it may cause a rebounding of symptoms and it has a high incidence of local toxicity and hypersensitivity.
  • A topical astringent or antibiotic may be instilled 4 times per day to prevent bacterial superinfection.
  • Topical steroids dramatically suppress conjunctival inflammatory signs, relieve symptoms, and are associated with resolution of the corneal subepithelial infiltrates. However, due to their adverse effects, topical steroids should only be used for pseudomembranes or when subepithelial infiltrates severely reduce vision. Subepithelial infiltrates may recur after discontinuing the steroids. Therapy should be maintained for one to a few weeks and then slowly tapered over months. Extreme caution must be taken when giving steroids to any patient with follicular conjunctivitis because it may worsen an underlying herpes simplex viral infection. Furthermore, topical steroids should be avoided during the first 2 weeks of infection during active viral replication.
  • Although adenovirus has been found to be sensitive to idoxuridine and trifluorothymidine in vitro, none of the commercially available antivirals have been shown to be effective clinically. On the other hand, topical cidofovir has been shown to be highly effective in the eradication of actively replicating viruses and limiting the time of symptomatology. Further clinical study is warranted to determine the long-term adverse effects of topical cidofovir, including the possibility of epithelial toxicity, secondary corneal infiltrates, and punctal stenosis. Topical cidofovir is also effective clinically against herpes simplex, molluscum contagiosum, and human papilloma virus.
  • Topical human fibroblast interferon has been shown to have some success, but it is still an experimental treatment.
  • An in vitro study using adenovirus 8 and A549 human epithelial cell cultures demonstrated that povidone-iodine at a concentration of 1:10 (0.8%) is highly effective against free adenovirus, less effective against intracellular adenoviral particles in already infected cells, and not significantly cytotoxic for healthy cells. Thus, povidone-iodine 0.8% may represent a potential option to reduce contagiousness in cases of adenoviral infections.

If a membrane or pseudomembrane is present, it may be peeled off gently, and a topical steroid may be prescribed. If a symblepharon is forming, the membrane or the pseudomembrane should be removed. Frequent ointment therapy is also useful.

Corneal consultation may be needed for nonresolving or severe keratitis or for steroid-related complications.

Families should be forewarned of the extremely contagious nature of this infection. Fomites, including napkins, towels, pillowcases, and clothing, should not be shared. Hand washing is also essential to avoid transmission. Health care workers may be precluded from patient contact for up to 2 weeks because of this infection, particularly if they work regularly with individuals who are immunocompromised. In general, workers with significant contact with people should not work until the weeping stops, which typically takes 1-2 weeks.