Coxsackieviruses Treatment & Management

  • Author: Martha L Muller, MD; Chief Editor: Michael Stuart Bronze, MD  more...
Updated: Aug 15, 2016

Medical Care

Medical care is generally supportive and can be offered on an outpatient basis. More severe symptoms may require inpatient admission for further workup and intervention.

Aseptic meningitis

Treatment is mainly supportive.

Pleconaril, an enteroviral capsid-stabilizing drug, appeared to reduce symptoms in a randomized double-blind study (N = 33),[7] but has not been licensed by the Food and Drug Administration (FDA).

Not all patients require hospitalization, but consider admission for patients with changes in mental status or neurologic deficits.


IVIG has been of anecdotal benefit, but no randomized trials have been conducted. A large prospective trial of prednisone with cyclosporine or azathioprine showed no difference compared to supportive treatment alone.[8] Recent experiments have shown that carvedilol, a nonselective beta-blocker, attenuates myocardial lesions and decreases myocardial virus replication in a murine model. However, this intervention has not been evaluated in humans.[9]

Epidemic pleurodynia

Analgesics, narcotics, and heating pads are the mainstays of therapy. All patients recover completely within 1 week.

Acute hemorrhagic conjunctivitis (AHC)

Treatment is symptomatic, and no antimicrobial agent is necessary in the absence of bacterial superinfection.


Both IVIG and pleconaril have been used in immunocompromised patients with enteroviral infections (neonates and B-cell immunodeficient) with varying success.

In vitro studies have suggested that arbidol may have potential as a future antiviral agent with activity against coxsackievirus, but no trials in humans have yet been performed.[10]


Surgical Care

No surgical intervention is necessary unless patients develop complications such as meningitis and/or encephalitis with increased intracranial pressure, which requires ventriculostomy, or heart failure, which requires valve repair or cardiac transplant.



Consultations play an important role in patients with complex presentations.

A neurologist may help to evaluate patients who present with abnormal neurologic symptoms or to manage rare complications associated with meningitis.

A neurosurgeon may be needed to assist with obtaining brain biopsies or placing a ventriculostomy tube because of increased intracranial pressure.

A cardiologist helps with diagnosis and management of arrhythmia, heart failure, and heart block associated with myocarditis.



Diet is as tolerated.



Bedrest is indicated for some patients.

Contributor Information and Disclosures

Martha L Muller, MD Associate Professor of Pediatrics, Division of Infectious Diseases, University of New Mexico School of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

John W King, MD Professor of Medicine, Chief, Section of Infectious Diseases, Director, Viral Therapeutics Clinics for Hepatitis, Louisiana State University Health Sciences Center; Consultant in Infectious Diseases, Overton Brooks Veterans Affairs Medical Center

John W King, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Federation for Medical Research, Association of Subspecialty Professors, American Society for Microbiology, Infectious Diseases Society of America, Sigma Xi

Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, Oklahoma State Medical Association, Southern Society for Clinical Investigation, Association of Professors of Medicine, American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

Maria D Mileno, MD Associate Professor of Medicine, Division of Infectious Diseases, The Warren Alpert Medical School of Brown University

Maria D Mileno, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, International Society of Travel Medicine, Sigma Xi

Disclosure: Nothing to disclose.


Mashiul H Chowdhury, MD Assistant Professor, Department of Medicine, Division of Infectious Disease, Program Director, Infectious Disease Fellowship, Director, TravelHealth Center, Drexel University College of Medicine

Disclosure: Nothing to disclose.

Nhat M Doan, MD Fellow, Department of Internal Medicine, Division of Infectious Diseases, Washington Hospital Center

Disclosure: Nothing to disclose.

Parul Kaushik, MD, MPH Fellow, Department of Medicine, Division of Infectious Disease, Drexel University College of Medicine

Disclosure: Nothing to disclose.

Michael Rajnik, MD Associate Professor, Department of Pediatrics, Program Director, Pediatric Infectious Disease Fellowship Program, Uniformed Services University of the Health Sciences

Michael Rajnik is a member of the following medical societies: American Academy of Pediatrics, Armed Forces Infectious Disease Society, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society.

Disclosure: Nothing to disclose.

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