Management of a severe initial episode of oral mucocutaneous herpes in an immunocompetent patient
Treat immunocompetent patients with a severe initial episode of oral mucocutaneous herpes with oral antiviral therapy. Few studies compare valaciclovir or famciclovir with aciclovir for initial episodes of oral mucocutaneous herpes. However, available evidence suggests that the three drugs are therapeutically equivalent. Ease of administration and cost should be considered when choosing therapy. Treatment is most effective when started promptly, but only reduces the duration of symptoms by about 24 hours and does not appear to diminish recurrences.
For treatment of a severe initial episode of oral mucocutaneous herpes in an immunocompetent adult, use:
1famciclovir 500 mg orally, 12-hourly for 7 days1 famciclovir famciclovir famciclovir
OR
1valaciclovir 1 g orally, 12-hourly for 7 days1 valaciclovir valaciclovir valaciclovir
OR
2aciclovir 200 mg orally, 5 times daily for 7 days1. aciclovir aciclovir aciclovir
For treatment of a severe initial episode of oral mucocutaneous herpes in a child younger than 3 months, seek 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 to 7 days 21. 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.