From the Guidelines
Herpes simplex infections affecting the head should be treated with antiviral medications such as acyclovir, valacyclovir, or famciclovir to reduce the duration and severity of outbreaks. For treatment, I recommend starting with acyclovir (400mg orally five times daily for 5-10 days), valacyclovir (1g twice daily for 7-10 days), or famciclovir (250mg three times daily for 7-10 days) [ 1 ]. Some key points to consider when treating herpes simplex infections of the head include:
- Apply topical treatments like docosanol 10% cream (Abreva) at the first sign of symptoms
- For pain relief, use acetaminophen or ibuprofen as needed
- Keep the affected area clean and dry, avoid touching or picking at sores, and wash hands frequently to prevent spreading the infection
- Apply cold compresses to reduce pain and swelling
- If symptoms are severe, recurrent, or accompanied by fever, eye involvement, or occur in immunocompromised individuals, seek immediate medical attention as complications can be serious [ 1 ]. In cases of suspected viral encephalitis, such as HSV encephalitis, treatment with intravenous aciclovir for 14-21 days is recommended, with a repeat lumbar puncture (LP) considered at this time to confirm the cerebrospinal fluid (CSF) is negative for HSV by PCR [ 1 ].
From the FDA Drug Label
Herpes Simplex Encephalitis Sixty-two patients ages 6 months to 79 years with brain biopsy-proven herpes simplex encephalitis were randomized to receive either acyclovir (10 mg/kg every 8 hours) or vidarabine (15 mg/kg/day) for 10 days (28 were treated with acyclovir and 34 with vidarabine) Overall mortality at 12 months for patients treated with acyclovir was 25% compared to 59% for patients treated with vidarabine.
- Key points:
- Acyclovir is used to treat herpes simplex encephalitis.
- The recommended dose is 10 mg/kg every 8 hours for 10 days.
- Acyclovir has been shown to decrease mortality and improve outcomes in patients with herpes simplex encephalitis 2. The answer is: Acyclovir can be used to treat herpes simplex head (encephalitis) with a dose of 10 mg/kg every 8 hours for 10 days.
From the Research
Herpes Simplex Head Infections
- Herpes simplex encephalitis (HSE) is a life-threatening consequence of herpes simplex virus (HSV) infection of the central nervous system (CNS) 3.
- The International Herpes Management Forum (IHMF) has issued guidelines to aid the diagnosis and treatment of HSE, including the use of polymerase chain reaction (PCR) of the cerebrospinal fluid (CSF) as the diagnostic method of choice 3.
- Antiviral therapy, such as intravenous aciclovir, is most effective when started early and is recommended for 14-21 days 3, 4.
Treatment and Management
- The Infectious Disease Society of America (IDSA) recommends 2-3 weeks of intravenous acyclovir at 10 mg/kg every 8 h, depending on the clinical course 4.
- Some studies suggest that adjunctive immunomodulatory therapy, such as intravenous immunoglobulin (IVIG) and glucocorticoids, may be beneficial in severe cases of HSE 5.
- However, the use of oral valaciclovir as an alternative to intravenous aciclovir is not recommended outside of a controlled research setting due to concerns about its efficacy and safety 6.
Diagnosis and Prognosis
- PCR of the CSF is the diagnostic method of choice for HSE, but negative results need to be interpreted in the context of the patient's clinical presentation and the timing of the CSF sampling 3.
- The prognosis for HSE is generally poor, with mortality rates reaching 70% in the absence of therapy and only a minority of individuals returning to normal function 3.
- Long-term neurological sequelae are common in survivors of HSE, and individualization of treatment duration based on follow-up CSF analysis may be necessary 4.