A significant advance in the management of herpes simplex infections was the discovery of acyclovir, which has no effect on normal cells but inhibits DNA replication in HSV-infected cells.
Acyclovir has been shown to be effective in the treatment of primary oral HSV in children when therapy was started in the first 72 hours. Acyclovir significantly decreased days of fever, pain, lesions, and viral shedding.
Acyclovir has been shown to be effective in the treatment of primary oral HSV in children when therapy was started in the first 72 hours. Acyclovir significantly decreased days of fever, pain, lesions, and viral shedding.
Newer antiherpes drugs are now available, including valacyclovir and famciclovir. The advantage of the newer drugs is increased bioavailability, allowing for effective treatment with fewer doses.
Milder cases can be managed with supportive care only. The use of antiviral drugs in the management of recurrent disease or in immunocompromised patients is discussed later in this chapter in sections on recurrent and chronic HSV.
Routine supportive measures include aspirin or acetaminophen for fever and fluids to maintain proper hydration and electrolyte balance. If the patient has difficulty eating and drinking, a topical anesthetic may be administered prior to meals. Dyclonine hydrochloride 0.5% has been shown to be an excellent topical anesthetic for the oral mucosa. If this medication is not available, a solution of diphenhydramine hydrochloride 5 mg/mL mixed with an equal amount of milk of magnesia also has satisfactory topical anesthetic properties. Infants who are not drinking because of severe oral pain should be referred to a pediatrician for maintenance of proper fluid and electrolyte balance.
Antibiotics are of no help in the treatment of primary herpes infection, and use of corticosteroids is contraindicated. Future therapy may include prevention of the infection with use of a genetically disabled HSV vaccine.