Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ACUTE

all patients

1st line – analgesics and antipyretics

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ACUTE
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all patients
1st line – 

analgesics and antipyretics

Simple oral analgesics and antipyretics such as paracetamol and ibuprofen may be used to lower fever and relieve pain.

Aspirin is not recommended for fever due to its association with Reye's syndrome.

Primary options

paracetamol: children <12 years of age: 15 mg/kg orally every 4-6 hours when required, maximum 75 mg/kg/day; children >12 years of age: 500-1000 mg orally every 4-6 hours when required, maximum 4000 mg/day

OR

ibuprofen: children <12 years of age: 5-10 mg/kg orally every 6-8 hours when required, maximum 40 mg/kg/day; children >12 years of age: 300-400 mg every 6-8 hours when required, maximum 2400 mg/day

Consider – topical anaesthetics

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ACUTE
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all patients
Consider – 

topical anaesthetics

Additional treatment recommended for SOME patients in selected patient group

Lidocaine can be used topically as an initial treatment for small, sparse mouth ulcers.

A mixture of aluminium and magnesium hydroxide, diphenhydramine, and viscous lidocaine with or without sucralfate can also be used topically for symptomatic pain control of mouth ulcers. A pharmacist must be consulted to make up this mixture.

Swishing elixir or mixture around in the mouth is not suitable for young children; elixir should be applied using a cotton-tipped applicator.

Primary options

lidocaine topical: (2% viscous solution) apply to the affected area(s) with a cotton-tip applicator up to three times daily when required

Consider – adequate fluid and nutritional intake

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ACUTE
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all patients
Consider – 

adequate fluid and nutritional intake

Additional treatment recommended for SOME patients in selected patient group

Maintaining adequate fluid and nutritional intake is important but may be difficult in patients with oral ulcers.

For children with moderate-to-severe dehydration, intravenous hydration may be necessary.

Plus – hospitalisation and supportive treatment

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ACUTE
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all patients
|
with immunocompromise or complications or EV71 infection
Plus – 

hospitalisation and supportive treatment

Treatment recommended for ALL patients in selected patient group

Complications are rare. Hospitalisation and supportive treatment for complications is likely to be required for these patients.

The complications that can occur with enterovirus 71 (EV71) infection include aseptic meningitis, encephalitis, encephalomyelitis, pulmonary oedema, pulmonary haemorrhage, myocarditis, a polio-like syndrome, and death.[7][8][9][10]

In immunocompromised patients, symptoms may be more severe and prolonged.

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Choose a patient group to see our recommendations

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

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