What is the best treatment for a 21-month-old with a herpes simplex virus (HSV) outbreak?

From the Guidelines

For a 21-month-old with a viral herpes outbreak, the most effective treatment is oral acyclovir suspension, typically dosed at 20 mg/kg three times daily for 5-10 days, as recommended by the CDC and the Infectious Diseases Society of America 1. This treatment approach is crucial in reducing the severity and duration of the outbreak. It is essential to consult a pediatrician immediately to initiate prescription antiviral medication. In addition to antiviral medication, it is recommended to:

• Keep the affected areas clean and dry using gentle soap and water
• Dress the child in loose-fitting clothes to prevent irritation
• Use children's acetaminophen (Tylenol) for pain relief, following weight-based dosing instructions on the package
• Ensure the child stays well-hydrated and gets plenty of rest
• Avoid touching the sores and wash hands frequently to prevent spreading the infection to other body parts or family members
• Separate the child's towels, washcloths, and utensils to prevent the spread of infection. The antiviral medication works by preventing the virus from replicating, which helps reduce symptoms and shortens the duration of the outbreak, as supported by the guidelines for the prevention and treatment of opportunistic infections among HIV-exposed and HIV-infected children 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 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.

The best way to treat a 21-month-old with a viral herpes outbreak is with intravenous acyclovir at a dose of 10 mg/kg every 8 hours 2.

• The treatment should be given for a duration that is consistent with the severity of the infection, but the label does not specify the exact duration for this age group.
• Monitoring for potential side effects and adjusting the dose as needed is crucial, especially in pediatric patients.
• It is essential to consult with a healthcare professional to determine the best course of treatment for the specific patient.

From the Research

Treatment Options for Viral Herpes Outbreak in a 21-Month-Old

• The use of antiviral drugs, such as acyclovir, is recommended for the treatment of herpes simplex virus infections in children 3, 4.
• Acyclovir is effective in treating herpes simplex virus encephalitis and can be used to treat other herpes simplex virus infections, including skin infections and gingivostomatitis 3, 5.
• The treatment of herpetic gingivostomatitis with acyclovir suspension has been shown to result in a more rapid regression of symptoms 6.
• Early treatment with acyclovir, within the first three days of disease onset, can significantly shorten the duration of clinical manifestations and infectivity in affected children 6.
• The proposed therapeutic dose of acyclovir for the treatment of herpetic gingivostomatitis is 15 mg/kg, 5 times daily for 5 days 6.

Considerations for Treatment

• The development of drug-resistant viral isolates, particularly in immunocompromised patients, is a concern with long-term prophylaxis with current antiviral drugs 7.
• New antiherpetic compounds with different mechanisms of action are being developed to address the issue of drug resistance 7.
• The treatment of herpes simplex virus infections should be initiated as soon as possible, and the choice of antiviral drug and dosage should be based on the individual patient's needs and the severity of the infection 3, 4.