Antiviral Treatment for HSV1 Infections

Treatment Options

• The Centers for Disease Control and Prevention recommends acyclovir 400 mg orally twice daily as the standard suppressive therapy regimen for adults and adolescents with recurrent episodes 1, 2
• For adults and adolescents with episodic treatment, acyclovir 400 mg orally three times daily for 5 days is recommended 1
• For children less than 45 kg, acyclovir 20 mg/kg body weight (maximum 400 mg/dose) orally three times daily for 5-10 days is recommended 3, 4
• Alternative regimens for adults include valacyclovir 500 mg orally twice daily for 5 days 1 and famciclovir 125 mg orally twice daily for 5 days 1

Special Populations

• For immunocompromised patients, acyclovir 400 mg orally three to five times daily until clinical resolution is recommended as an alternative regimen 5
• For severe cases in immunocompromised patients, acyclovir 5 mg/kg IV every 8 hours until clinical resolution is recommended 5

Important Considerations

• Short-course therapy (1-3 days) should not be used in immunocompromised patients 2
• For severe disease requiring hospitalization, intravenous acyclovir is indicated 5, 2

Treatment Duration

• Episodic therapy duration is 5-14 days depending on severity and immune status 1, 3, 4
• Suppressive therapy can be continued indefinitely, but reassessment after 12 months is recommended 1
• For CNS or disseminated disease, 21 days of therapy is recommended 3, 4