Pediatric Enteroviral Infections Medication

Updated: Jun 16, 2017
  • Author: Nicholas John Bennett, MBBCh, PhD, MA(Cantab), FAAP; Chief Editor: Russell W Steele, MD  more...
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Medication

Medication Summary

Antiviral therapy is not currently a component in the standard of care for enteroviral infection. Studies with investigational antiviral agents are currently ongoing. Current treatment remains purely supportive.

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Antipyretic and analgesic agents

Class Summary

These agents are used to treat fever, myalgia, and headache associated with enterovirus.

Acetaminophen (Tylenol, FeverAll)

Reduces fever by directly acting on hypothalamic heat-regulating centers, which increases dissipation of body heat via vasodilation and sweating.

Ibuprofen (Motrin, Advil)

One of the few NSAIDs indicated for reduction of fever.

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Immunoglobulins

Class Summary

This agent is a purified preparation of gamma globulin derived from large pools of human plasma and is composed of 4 subclasses of antibodies, approximating the distribution of human serum.

Immune globulin, intravenous (Carimune NF, Gammagard, Polygam S/D)

Neutralizes circulating myelin antibodies through anti-idiotypic antibodies. Down-regulates proinflammatory cytokines, including INF-gamma. Blocks Fc receptors on macrophages. Suppresses inducer T and B cells and augments suppressor T cells. Blocks complement cascade and promotes remyelination. May increase CSF IgG (10%).

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Antiviral agents

Class Summary

One antiviral medication (pleconaril) has shown promise in treating enteroviral infections, but its use has so far been largely restricted to experimental protocols. Its release has been repeatedly delayed, and it is still not yet licensed in the United States.

Pleconaril (Picovir)

Investigational in the United States. Low-molecular weight capsid-inhibitor fits into the hydrophobic pocket of the VP1 capsid protein and interferes with viral attachment and uncoating. Has shown efficacy against enterovirus species.

Several clinical trials in adults have shown good drug tolerability with low adverse effects. Drug distribution shows good penetration into the liver, CNS, and nasal mucosa. Efficacy demonstrated in terms of symptom scores, nasal mucus production, and length of illness in studies in which administration of the drug precedes or coincides with experimental enterococcus inoculation. Bioavailability increases more than 2-fold when administered with a fatty meal compared with administration in a fasting state. Treatment of subjects presenting with a "common cold" reduced the disease duration by about 1 d.

Several case reports document successful treatment of severe or life-threatening infections. Data in children is extremely limited. Studies are underway. Contact Schering-Plough for information regarding experimental protocols or compassionate need.

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