# Hand-Foot-and-Mouth Disease - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: WHO Guide on Hand, Foot and Mouth Disease 2011 · Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) · StatPearls: Ibuprofen (NCBI Bookshelf NBK542299) - Verified date: 2026-08 ## Verified against - WHO Guide on Hand, Foot and Mouth Disease 2011 - Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) - Hand, Foot, and Mouth Disease - disease-level clinical article (hand-foot-and-mouth-clinical.txt) - MSF Essential Drugs 2024 (ibuprofen oral monograph) - MSF Essential Drugs 2024 - paracetamol (oral) ## Treatment metadata - Paracetamol — 120 mg — oral.liquid - Referral & safety-netting (no drug therapy) - Ibuprofen — 100 mg — oral.liquid ## Complete treatment card ```text HAND-FOOT-AND-MOUTH DISEASE Sources: WHO Guide on Hand, Foot and Mouth Disease 2011 · Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) · StatPearls: Ibuprofen (NCBI Bookshelf NBK542299) Review status: REVIEWED against WHO Guide on Hand, Foot and Mouth Disease 2011, Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560), Hand, Foot, and Mouth Disease - disease-level clinical article (hand-foot-and-mouth- clinical.txt), MSF Essential Drugs 2024 (ibuprofen oral monograph), MSF Essential Drugs 2024 - paracetamol (oral) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (3) - HFMD often starts with a mild fever, poor appetite, and general malaise [fever · malaise · poor appetite] - Mouth or throat pain from the oral lesions is usually the first symptom noticed [sore throat] - The skin lesions are 2 to 6 mm across, are not itchy, are usually painless, and heal without scarring over about ten days [skin lesions] SIGNS - what you find (2) - Vesicles have a thin rim of redness around them and break down into shallow ulcers with a grey-yellow base and red edge [blisters · mouth ulcers · redness · vesicles] - The rash involves the hands, feet, buttocks, legs, and forearms, while mouth lesions usually affect the cheeks and tongue and sometimes the soft palate [rash] TESTS (3) - HFMD is diagnosed clinically in most cases without lab testing - A vesicle scraping under light microscopy can distinguish HFMD from chickenpox or herpes simplex - PCR testing of a swab from a lesion can confirm coxsackievirus or enterovirus infection IF NOT THIS - what else fits (4) - Monkeypox can be clinically difficult to distinguish from HFMD during an outbreak - Herpangina and herpes simplex are also on the differential - Kawasaki disease is on the differential for HFMD - Varicella zoster infection (chickenpox) is on the differential Source StatPearls "Hand, Foot, and Mouth Disease" - disease-level clinical article Status traced to the source above 1. PARACETAMOL [1st line] Adult 1 g 3 or 4 times daily (max. 4 g daily) x 5-7 days Peds 10-15 mg/kg/dose [child max 500 mg] (Child 1 month and over: 15 mg/kg 3 or 4 times daily (max. 60 mg/kg daily). Child under 1 month: 10 mg/kg 3 or 4 times daily (max. 40 mg/kg daily).) 3kg -> 30-45 mg/dose 4kg -> 40-60 mg/dose 5kg -> 50-75 mg/dose 6kg -> 60-90 mg/dose 7kg -> 70-105 mg/dose 8kg -> 80-120 mg/dose 9kg -> 90-135 mg/dose 10kg -> 100-150 mg/dose 11kg -> 110-165 mg/dose 12kg -> 120-180 mg/dose 13kg -> 130-195 mg/dose 14kg -> 140-210 mg/dose 15kg -> 150-225 mg/dose 16kg -> 160-240 mg/dose 17kg -> 170-255 mg/dose 18kg -> 180-270 mg/dose 19kg -> 190-285 mg/dose 20kg -> 200-300 mg/dose 21kg -> 210-315 mg/dose 22kg -> 220-330 mg/dose 23kg -> 230-345 mg/dose 24kg -> 240-360 mg/dose 25kg -> 250-375 mg/dose 26kg -> 260-390 mg/dose 27kg -> 270-405 mg/dose 28kg -> 280-420 mg/dose 29kg -> 290-435 mg/dose 30kg -> 300-450 mg/dose 31kg -> 310-465 mg/dose 32kg -> 320-480 mg/dose 33kg -> 330-495 mg/dose 34kg -> 340-500 mg/dose (upper capped) 35kg -> 350-500 mg/dose (upper capped) 36kg -> 360-500 mg/dose (upper capped) 37kg -> 370-500 mg/dose (upper capped) 38kg -> 380-500 mg/dose (upper capped) 39kg -> 390-500 mg/dose (upper capped) 40kg -> 400-500 mg/dose (upper capped) 41kg -> 410-500 mg/dose (upper capped) 42kg -> 420-500 mg/dose (upper capped) 43kg -> 430-500 mg/dose (upper capped) 44kg -> 440-500 mg/dose (upper capped) 45kg -> 450-500 mg/dose (upper capped) 46kg -> 460-500 mg/dose (upper capped) 47kg -> 470-500 mg/dose (upper capped) 48kg -> 480-500 mg/dose (upper capped) 49kg -> 490-500 mg/dose (upper capped) 50kg -> 500 mg/dose (capped) Source MSF Essential Drugs 2024 - paracetamol (oral) Why Analgesic and antipyretic used for symptomatic relief of fever, sore throat, and malaise in hand-foot-and-mouth disease, a self-limiting viral illness with no antiviral treatment and managed supportively. Caution Ensure soft diet and fluid intake to prevent dehydration. Antibiotics are ineffective and contraindicated. Watch for neurological complications: myoclonic jerks, lethargy, or ataxia (EV71 risk). 500 mg is the per-dose ceiling used here for a child. 1000 mg is the adult dose and does not belong in a weight calculation - the daily 60 mg/kg limit is the one that binds first in any case. Egypt CETAMOL 120MG/5ML PEDIATRIC SYRUP 120 ML MEMPHIS 8.50 EGP PARAGESIC BABY 120MG/5ML 120ML SUSP. AMRIYA 36.00 EGP PARAMOL 120MG/5ML SYRUP 125ML MISR 36.00 EGP FEBRIMOL ORAL DROPS 20 ML PHARCO 4.00 EGP -> ? strength differs, ? different route - not oral liquid THERA-LO 3.2G/100ML ORAL SUSP. 100 ML PHAROPHARMA 5.00 EGP -> ? strength differs, ? different route - not oral liquid 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Hand, Foot, and Mouth Disease - disease-level clinical article (hand-foot-and-mouth- clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - The risk factors for severe disease and mortality are lethargy, seizures, dyspnea, and coma. 3. IBUPROFEN [2nd line] Adult 400 mg 3 times daily after food x 5-7 days Peds 5-10 mg/kg/dose [child max 400 mg] (Every 6-8 hours after food;. Child over 3 months: 5 to 10 mg/kg 3 to 4 times daily, maximum 30 mg/kg daily. The suspension's own label caps pain-and-fever use lower still, at 20 mg/kg/day. Never exceed 400 mg in a single dose.) 3kg -> 15-30 mg/dose 4kg -> 20-40 mg/dose 5kg -> 25-50 mg/dose 6kg -> 30-60 mg/dose 7kg -> 35-70 mg/dose 8kg -> 40-80 mg/dose 9kg -> 45-90 mg/dose 10kg -> 50-100 mg/dose 11kg -> 55-110 mg/dose 12kg -> 60-120 mg/dose 13kg -> 65-130 mg/dose 14kg -> 70-140 mg/dose 15kg -> 75-150 mg/dose 16kg -> 80-160 mg/dose 17kg -> 85-170 mg/dose 18kg -> 90-180 mg/dose 19kg -> 95-190 mg/dose 20kg -> 100-200 mg/dose 21kg -> 105-210 mg/dose 22kg -> 110-220 mg/dose 23kg -> 115-230 mg/dose 24kg -> 120-240 mg/dose 25kg -> 125-250 mg/dose 26kg -> 130-260 mg/dose 27kg -> 135-270 mg/dose 28kg -> 140-280 mg/dose 29kg -> 145-290 mg/dose 30kg -> 150-300 mg/dose 31kg -> 155-310 mg/dose 32kg -> 160-320 mg/dose 33kg -> 165-330 mg/dose 34kg -> 170-340 mg/dose 35kg -> 175-350 mg/dose 36kg -> 180-360 mg/dose 37kg -> 185-370 mg/dose 38kg -> 190-380 mg/dose 39kg -> 195-390 mg/dose 40kg -> 200-400 mg/dose 41kg -> 205-400 mg/dose (upper capped) 42kg -> 210-400 mg/dose (upper capped) 43kg -> 215-400 mg/dose (upper capped) 44kg -> 220-400 mg/dose (upper capped) 45kg -> 225-400 mg/dose (upper capped) 46kg -> 230-400 mg/dose (upper capped) 47kg -> 235-400 mg/dose (upper capped) 48kg -> 240-400 mg/dose (upper capped) 49kg -> 245-400 mg/dose (upper capped) 50kg -> 250-400 mg/dose (upper capped) Source Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) for the adult dose: "The recommended dose is 200 mg-400 mg (10-20 ml), up to three times a day as required... do not take more than 1200 mg (60 ml) in any 24 hour period". That label's paediatric section gives weight bands and a 20 mg/kg/day pain-and-fever ceiling but states no mg/kg per dose, so the paediatric 5 to 10 mg/kg per dose is from MSF Essential Drugs 2024 (ibuprofen oral monograph): "Child over 3 months: 5 to 10 mg/kg 3 to 4 times daily (max. 30 mg/kg daily)". Why NSAID alternative for pain relief, particularly useful for painful oral ulcers that limit fluid intake; avoided in severe asthma or dehydration. Caution Reduces severe oral ulcer pain enabling fluid intake. Avoid in severe asthma or dehydration. Maintain hand hygiene to prevent household transmission. The 400 mg per-dose ceiling comes from the reference literature, not from the suspension label - that label's largest paediatric single dose is 200 mg. Below about 40 kg the weight calculation binds first and the ceiling never comes into it. Egypt NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML SANOFI 2.25 EGP IBUPROFEN 100MG/5ML SUSP. 120 ML SEDICO 5.00 EGP MARCOFEN 100MG/5ML SUSP. 120ML GLAXO SMITHKLINE 5.85 EGP MAFO 100MG/5ML SYRUP 100 ML EIPICO 25.00 EGP IBUCALMIN 100MG/5ML SYRUP 120 ML MASH PREMIERE 28.00 EGP JUSPOLED 100MG/5ML SYRUP 120 ML EGPI > JASPER... 31.00 EGP MEGAFEN-N 100MG/5ML SUSP. 120 ML RAMEDA 35.00 EGP BRUFEN 100MG/5ML SYRUP 150ML KAHIRA > ABBO... 44.00 EGP BRUFEMOL-N SUSP. 60 ML ARAB DRUG COM... 4.50 EGP -> ? strength differs, ? different route - not oral liquid IBUFEN 2% SUSP. 60ML ALEXANDRIA 4.50 EGP -> ? strength differs, ? different route - not oral liquid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)