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

INITIAL

gastrointestinal illness: poliovirus suspected

1st line – supportive care with rehydration + neurological monitoring

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INITIAL
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gastrointestinal illness: poliovirus suspected
1st line – 

supportive care with rehydration + neurological monitoring

Oral rehydration and/or intravenous fluids should be given to prevent volume depletion.

The patient should be monitored for acute flaccid paralysis (AFP), which indicates progression to paralytic poliomyelitis.

When poliovirus infection is suspected, the local health authority should be immediately notified. In disease-endemic countries, this may be the local office of the WHO.[1]

ACUTE

paralytic poliomyelitis (acute flaccid paralysis)

1st line – supportive care with physiotherapy + mobilisation

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ACUTE
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paralytic poliomyelitis (acute flaccid paralysis)
1st line – 

supportive care with physiotherapy + mobilisation

Supportive treatment entails early physiotherapy and mobilisation.

The patient should be monitored for progression of limb paralysis to respiratory paralysis.

When poliovirus infection is diagnosed or suspected, the local health authority should be immediately notified. In disease-endemic countries, this may be the local office of the WHO.[1]

Plus – transfer to specialised centre ± intubation

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ACUTE
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paralytic poliomyelitis (acute flaccid paralysis)
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with bulbar poliomyelitis (respiratory paralysis)
Plus – 

transfer to specialised centre ± intubation

Treatment recommended for ALL patients in selected patient group

Respiratory paralysis is a life-threatening condition requiring expert medical assistance, and immediate transport to a specialised centre for treatment is required.

Respiratory support measures include intubation and ventilation as needed.[1][48]

ONGOING

post-poliomyelitis syndrome (PPS)

1st line – supportive care with physiotherapy + mobilisation

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ONGOING
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post-poliomyelitis syndrome (PPS)
1st line – 

supportive care with physiotherapy + mobilisation

PPS may develop many years or even decades following paralytic poliomyelitis, and consists of fatigue, weakness, and wasting of affected muscles. Ongoing physiotherapy and mobilisation are required.[43][49][50]

A systematic review on pharmacologic and non-pharmacologic therapies found insufficient good-quality evidence to make definite recommendations concerning the various treatments used for PPS.[51]

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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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