From the Guidelines
Neonatal herpes should be treated with high-dose intravenous acyclovir at 20 mg/kg body weight/dose three times daily for 21 days for CNS and disseminated disease and for 14 days for skin, eye, and mouth disease. This treatment approach is based on the recommendations from the CDC, the National Institutes of Health, and the Infectious Diseases Society of America, as outlined in a study published in 2004 1. The use of acyclovir has been shown to reduce morbidity and mortality in infants with neonatal HSV infection.
- Key considerations in the treatment of neonatal herpes include:
- The dose and duration of intravenous acyclovir therapy, which should be administered for 21 days for CNS and disseminated disease and for 14 days for skin, eye, and mouth disease
- The importance of not discontinuing acyclovir therapy in neonates with CNS disease unless a repeat CSF HSV DNA PCR assay is negative at day 19-21 of treatment, as recommended by the study 1
- The potential for neurologic sequelae in infants with neonatal HSV infection, particularly those with CNS disease
- It is essential to initiate treatment as soon as herpes is suspected, without waiting for test results, to improve outcomes.
- After completing intravenous therapy, suppressive therapy with acyclovir may be considered to prevent recurrences and improve neurodevelopmental outcomes, although the specific details of this approach are not addressed in the provided study 1.
From the FDA Drug Label
Neonatal Herpes Simplex Virus Infection Two hundred and two infants with neonatal herpes simplex infections were randomized to receive either acyclovir 10 mg/kg every 8 hours (n = 107) or vidarabine 30 mg/kg/day (n = 95) for 10 days. Acyclovir for Injection is indicated for the treatment of neonatal herpes infections.
The treatment for neonatal herpes is acyclovir 10 mg/kg every 8 hours for 10 days 2.
- Indication: Acyclovir for Injection is indicated for the treatment of neonatal herpes infections 2.
- The dosage of 10 mg/kg every 8 hours has been studied in clinical trials and shown to be effective in treating neonatal herpes simplex virus infection 2.
From the Research
Treatment Options for Neonatal Herpes
- Acyclovir is a commonly used treatment for neonatal herpes simplex virus disease, with a recommended dosage of 60 mg/kg/d 3
- Treatment with high-dose acyclovir has been shown to improve outcomes in neonatal herpes simplex virus infections 4
- Intravenous administration of acyclovir is typically used for hospitalized patients, while oral acyclovir or other antiviral therapies may be used for ambulatory patients 5
Administration and Dosage
- High-dose acyclovir therapy (60 mg/kg/d) is recommended for neonatal herpes simplex virus disease, although this dosage is not currently approved for infants by the US Food and Drug Administration 3
- Continuous acyclovir infusion has been shown to be effective in eliminating herpes simplex virus from the central nervous system in a case of neonatal herpes simplex virus encephalitis 6
- The dosage and administration of acyclovir may vary depending on the severity and extent of the disease, as well as the age and weight of the infant 5, 4
Safety and Efficacy
- Adverse events associated with acyclovir treatment are common but usually not severe, and may include hypotension, seizure, thrombocytopenia, and elevated creatinine 3
- The safety and efficacy of acyclovir treatment have been demonstrated in several studies, including a study of 89 infants with neonatal herpes simplex virus disease treated with high-dose acyclovir 3
- Empiric acyclovir treatment has been shown to be effective in optimizing future management of neonatal herpes simplex virus infection, although clinicians may need to consider the diagnosis more often and perform more complete investigations to rule out the infection 7