Key result
In hospitalized children with mild hand-foot-mouth disease, the use of the antiviral traditional Chinese herb Lan-Qin was associated with a higher recovery rate and shorter hospital stay compared to conventional therapy, whereas steroids and IVIG showed no significant advantage.
Why the study?
Does the use of steroids, IVIG, or traditional Chinese herbs improve recovery and reduce hospital stay in hospitalized children with hand-foot-mouth disease?
Observational (n=3,778)
No
Does the use of steroids, IVIG, or traditional Chinese herbs improve recovery and reduce hospital stay in hospitalized children with hand-foot-mouth disease?
Absolute Event Rate: 96.5% vs 94.6%
p-value: p=<0.05
In a retrospective cohort of children with hand-foot-mouth disease, the use of steroids and IVIG showed no significant advantage in mild cases and was associated with longer hospital stays, whereas the traditional Chinese herb Lan-Qin was associated with a higher recovery rate.
Caution against steroid/IVIG use in mild HFMD; leaves open Lan-Qin benefit for prospective trials.
BACKGROUND: In contrast to the guidelines of World Health Organization (WHO) and United States-Centers for Disease Control and prevention (US-CDC), the Chinese national guidelines recommend the use of steroids, intravenous immunoglobulin (IVIG), or traditional Chinese herbs (TCHs) in hand-foot-mouth disease (HFMD) management. Their use and therapeutic efficacies are, however, unclear. We aimed to describe their use in and the clinical outcomes of hospitalized HFMD cases. METHODS: A retrospective review of hospital medical records for HFMD cases during 2008-2016 was conducted in a medical school-affiliated tertiary hospital in Shantou, Guangdong, China. RESULTS: Hospitalized children with the discharge diagnosis of HFMD (n = 3778), comprising mild (58.4%), severe (41.5%), and very severe (0.1%) cases, were enrolled in the study. Steroids, IVIG, and antiviral TCH Lan-Qin were respectively prescribed in 60.5, 37.1, and 71.0% of cases. Most cases (99.8%) recovered and six died. Recovery rate was lower with the use of IVIG and higher with Lan-Qin (alone or in combination with steroid) in the mild cases (Ps < 0.05). Longer hospital stay was observed with steroid/IVIG with or without Lan-Qin in the severe cases (Ps < 0.05). CONCLUSIONS: This nine-year retrospective review shows 1) an increase in the incidence of HFMD as well as the use of steroids, IVIG, and TCH over time, 2) no significant advantage of using steroids and IVIG, either alone or in combination, in the management of mild HFMD cases, and 3) a higher recovery rate in mild HFMD cases with the use of antiviral TCH (Lan-Qin). Our findings need verification in a larger prospect study with cases from hospitals in other regions of China. Lan-Qin efficacy should be evaluated in randomized trials. Meanwhile, caution should be exercised in the extensive use of steroids and IVIG in HFMD management.
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Zhang et al. (2018) conducted an observational in Hand-foot-mouth disease (HFMD) (n=3,778). Lan-Qin (traditional Chinese herb) vs. No Lan-Qin / conventional supportive therapy was evaluated on Recovery rate in mild HFMD cases (p=<0.05). In hospitalized children with mild hand-foot-mouth disease, the use of the antiviral traditional Chinese herb Lan-Qin was associated with a higher recovery rate and shorter hospital stay compared to conventional therapy, whereas steroids and IVIG showed no significant advantage.
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