Management of infrequent but severe recurrences of oral mucocutaneous herpes in an immunocompetent patient

For immunocompetent patients with infrequent but severe recurrences of oral mucocutaneous herpes (eg difficulty eating or swallowing, complicated by erythema multiforme), episodic oral antiviral therapy can be used. Treatment is effective if started within 48 hours of symptoms; if possible, start treatment at the first sign of recurrence or during the prodromal stage.

For treatment of infrequent but severe recurrence of oral mucocutaneous herpes in an immunocompetent adult, useChen, 2017:

1famciclovir 1500 mg orally, as a single dose1 famciclovir famciclovir famciclovir

OR

1valaciclovir 2 g orally, 12-hourly for 1 day1 valaciclovir valaciclovir valaciclovir

OR

2aciclovir 200 mg orally, 5 times daily for 5 days1. aciclovir aciclovir aciclovir

For treatment of infrequent but severe recurrence of oral mucocutaneous herpes in a child younger than 3 months, see specialist advice. For an immunocompetent child older than 3 months, use:

aciclovir 10 mg/kg up to 200 mg orally, 5 times daily for 5 days21. aciclovir aciclovir aciclovir

If the patient is unable to swallow, refer for specialist advice and intravenous antiviral therapy.

To reduce the risk of virus transmission, advise patients with an active HSV infection to avoid direct contact of the lesion with other people. Children who do not have control of oral secretions should be excluded from childcare and school. Barrier cream (eg petroleum jelly) applied to the lips can help prevent adhesionsThe Royal Children's Hospital (RCH), 2020.

1 At the time of writing, this drug is not available on the Pharmaceutical Benefits Scheme (PBS) for this indication. See the PBS website for current information.Return
2 Aciclovir dosing in obesity is poorly defined; however, limited data support dosing based on ideal body weight in children.Return