infectious diseases
Herpes Simplex Virus (HSV) Infections
Treatment of Herpes Simplex Virus
Usuallyacyclovir,valacyclovir, orfamciclovir For keratitis, topicaltrifluridine(typically in consultation with an ophthalmologist) Treating primary HSV infection with medications, even if done early, does not prevent the possibility of recurrence. Isolated infections often go untreated without consequence. Acyclovir,valacyclovir, orfamciclovircan be used to treat infection, especially when it is primary. Infection withacyclovir-resistant HSV is rare and occurs almost exclusively in patients who are immunocompromised.Foscarnetmay be effective foracyclovir-resistant infections. Secondary bacterial infections are treated with topical antibiotics (eg,mupirocinorneomycin-bacitracin) or, if severe, with systemic antibiotics (eg, penicillinase-resistant beta-lactams). Systemic analgesics may help. Gingivostomatitisandpharyngitismay require symptom relief with topical anesthetics (eg, dyclonine,benzocaine, viscouslidocaine). (NOTE:Lidocainemust not be swallowed because it anesthetizes the oropharynx, the hypopharynx, and possibly the epiglottis. Children must be watched for signs of aspiration.) Severe cases can be treated withacyclovir,valacyclovir, orfamciclovir. Herpes labialisresponds to oral and topicalacyclovir. The duration of a recurrent eruption may be decreased by about a day by applyingpenciclovir1% cream every 2 hours while awake for 4 days, beginning during the prodrome or when the first lesion appears. Toxicity appears to be minimal.Famciclovir1500 mg as one dose orvalacyclovir2 g orally every 12 hours for 1 day can be used to treat recurrent herpes labialis.Acyclovir-resistant strains are resistant topenciclovir,famciclovir, andvalacyclovir.Docosanol10% cream may be effective when used 5 times a day. Herpetic whitlowheals in 2 to 3 weeks without treatment. Topicalacyclovirhas not been shown to be effective. Oral or IVacyclovircan be used in immunosuppressed patients and those with severe infection. Treating primary herpes infection with medications, even if done early, does not prevent recurrence. Treatment involves topical antivirals, such as IVacyclovirshould be used for therapy. Encephalitis is treated with IVacyclovir. Treatment for 14 to 21 days is preferred to prevent potential relapse. Viral meningitis is usually treated with IVacyclovir.Acycloviris generally very well-tolerated. However, adverse effects can include phlebitis, renal dysfunction, and, rarely, neurotoxicity (lethargy, confusion, seizures, coma; usually in the setting of renal insufficiency). 