Management of frequent and severe recurrences of oral mucocutaneous herpes in an immunocompetent patient
For immunocompetent patients with frequent and severe recurrences of oral mucocutaneous herpes (eg frequent disabling recurrences, frequent recurrences complicated by erythema multiforme), long-term suppressive therapy may be consideredChi, 2015.
For long-term suppressive therapy of frequent and severe recurrences of oral mucocutaneous herpes in an immunocompetent adult, consider:
1famciclovir 250 mg orally, twice daily for 6 months, then review1 famciclovir famciclovir famciclovir
OR
1valaciclovir 500 mg orally, once daily for 6 months, then review1 valaciclovir valaciclovir valaciclovir
OR
2aciclovir 400 mg orally, 12-hourly for 6 months, then review1. aciclovir aciclovir aciclovir
For long-term suppressive therapy of frequent and severe recurrences of oral mucocutaneous herpes in a child younger than 3 months, seek specialist advice. For an immunocompetent child older than 3 months, consider:
aciclovir 10 mg/kg up to 400 mg orally, 12-hourly for 6 months, then review21. aciclovir aciclovir aciclovir
Consider higher doses if prophylaxis is unsuccessful.
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.
Seek specialist advice if patients present with ongoing recurrent episodes despite being on long-term suppressive therapy.