Pharmaceutical Drugs

Pleconaril is a drug that interferes with enterovirus attachment and uncoating by binding to the virus protein capsid. It was once the most promising candidate for the treatment of enteroviral infections because of its oral bioavailability, penetration into the central nervous system, and efficacy in reducing the duration of symptoms and morbidity in neonatal sepsis and adult meningitis. It was used on a compassionate basis until 2003, when the US Food and Drug Administration (FDA) declined its license. Pleconaril is being investigated for intranasal treatment of rhinovirus infections and is now licensed by Schering Plough. Other drugs with similar actions are being developed by other drug companies.

Intravenous Immune Globulins (IVIG) have been suggested to be beneficial in the outcome of enterovirus myocarditis, infection in newborns, and in patients with agammaglobulinemia . Immunocompromised patients have also benefited from this treatment. Pre-exposure prophylaxis with immunoglobulins reduces the risk of paralysis in patients with severe enteroviral infections.

Beta Interferon is used to treat viral myocarditis patients with enteroviral infections. While indicated for the treatment of multiple sclerosis, this injectable drug is not approved by the US FDA for the treatment of any viral infection; although it seems to show success in Europe. It still can be used "off label" by physicians but the risk and benefit need to be clearly defined before starting this treatment. Side effects can be difficult to tolerate in some patients. The treatment is a six-month protocol 8x106 IU Betaferon or Beneferon/injection, given every other day. The cost is close to $2500 to $3000/month. Click here for more information

The combination of alpha and gamma interferons has been used to treat a limited number of enterovirus patients with an efficacy of 45%. Patients with severe body pain (fibromyalgia) seemed to respond the best, and the remission could last more than 2 years. The 3-month treatment is not US FDA-approved and costs approximately $5000/month. The side effects can be significant.