From the Guidelines
Herpes simplex virus type 1 (HSV-1) infections can be treated with antiviral medications to reduce symptoms and shorten outbreaks, with the most recent guidelines recommending valacyclovir (1000mg twice daily for 7-10 days) as a first-line treatment for initial episodes 1. For a first-time outbreak, oral acyclovir (400mg three times daily for 7-10 days), valacyclovir (1000mg twice daily for 7-10 days), or famciclovir (250mg three times daily for 7-10 days) are recommended. Some key points to consider when treating HSV-1 include:
- For recurrent outbreaks, the same medications can be used but for a shorter duration of 5 days, with valacyclovir potentially used as a single-day treatment (2000mg followed by another 2000mg 12 hours later) 1.
- For patients with frequent recurrences (more than 6 per year), suppressive therapy may be appropriate using acyclovir (400mg twice daily), valacyclovir (500mg daily), or famciclovir (250mg twice daily) continuously, as daily suppressive therapy reduces the frequency of HSV recurrences by at least 75% among patients with frequent recurrences 1.
- These medications work by inhibiting viral DNA synthesis, preventing the virus from replicating.
- In addition to medication, keeping the affected area clean and dry, avoiding touching or picking at sores, washing hands frequently, and avoiding triggers like stress, fatigue, and excessive sun exposure can help manage HSV-1.
- While these treatments can control symptoms, it's essential to understand that HSV-1 remains dormant in the body and there is currently no cure that completely eliminates the virus. The most recent study from 2022 1 provides the best guidance on the treatment of HSV-1, and its recommendations should be prioritized in clinical practice.
From the FDA Drug Label
The efficacy and safety of famciclovir have not been established as suppressive therapy in infants following neonatal HSV infections. Study 3 was an open-label, single-arm study to evaluate the pharmacokinetics, safety, and antiviral activity of a single 1500 mg dose (three 500 mg tablets) of famciclovir in children 12 to less than 18 years of age with recurrent herpes labialis
The treatment of HSV 1 with famciclovir is not established in pediatric patients, and the available data are insufficient to support its use in children 1 to less than 12 years of age with infections due to HSV. However, for patients 12 to less than 18 years of age with recurrent herpes labialis, a single 1500 mg dose of famciclovir may be considered, but the efficacy results in this population are not conclusive 2.
- Key points:
- Famciclovir is not recommended in infants with HSV infections.
- The efficacy of famciclovir for the treatment of HSV 1 in pediatric patients has not been established.
- A single 1500 mg dose of famciclovir may be considered in patients 12 to less than 18 years of age with recurrent herpes labialis, but with caution and careful evaluation of the available data.
From the Research
Treatment Options for HSV-1
- Current treatments for HSV-1 include antiviral medications such as acyclovir, which targets viral DNA polymerase 3
- However, these treatments have limited efficacy and are susceptible to resistance, especially in immunosuppressed populations 3
- Novel drugs such as helicase primase inhibitors (HPIs) are emerging as a promising alternative, showing high efficacy and the potential to overcome resistance 3
- Other treatment options include valacyclovir, a prodrug of acyclovir, and famciclovir, a prodrug of penciclovir, which have been shown to be effective in treating herpes simplex and herpes zoster infections 4, 5
Antiviral Therapy
- Antiviral treatment of herpesvirus infections is rapidly changing with the advent of new drugs with improved oral availability 4
- Aciclovir is still the standard therapy for severe herpes simplex virus (HSV) and varicella virus infections, but the development of resistance against aciclovir is a concern in immunocompromised patients 4
- Foscarnet is the current treatment of choice for aciclovir-resistant HSV strains 4
- Valacyclovir has been shown to be effective in treating herpes labialis, genital herpes, and herpes zoster, and is the only oral antiviral agent approved for therapy of herpes labialis 5
Evidence-Based Review
- A review of the treatment of herpes simplex infections found that choosing an appropriate drug and dosing regimen can be confusing due to competing clinical approaches and evolving dosing schedules 6
- The review provided a handy clinical reference for evidence-based dosing regimens for oral and genital infections 6
- An update on anti-HSV-1 agents highlighted the need for new compounds or therapies to address the issue of resistance, and provided an overview of the progress made over approximately 60 years regarding anti-HSV-1 agents 7