From the Research
Penciclovir cream is not an appropriate first-line therapy for an immunocompetent patient diagnosed with herpes simplex virus 1 infection gingivostomatitis. The recommended first-line treatment is oral antiviral therapy, specifically oral acyclovir, valacyclovir, or famciclovir, as they have been shown to be effective in reducing symptom duration and severity 1.
- The oral mucosa has different absorption characteristics compared to skin, and the widespread nature of gingivostomatitis requires systemic distribution of the antiviral medication to effectively reach all affected tissues.
- Topical treatments like penciclovir cream have poor penetration and limited efficacy for oral mucosal lesions, making them substantially less effective than systemic therapy.
- Early treatment (within 72 hours of symptom onset) provides the greatest benefit in reducing symptom duration and severity, and supportive care including adequate hydration, pain management with acetaminophen or ibuprofen, and saltwater rinses should accompany antiviral therapy 2, 3.
- The most recent and highest quality study, a systematic review published in 2023, found that only one study provided weak evidence that acyclovir is an effective treatment, improving healing of oral lesions and reducing duration of symptoms 1.
- Therefore, oral antiviral therapy with acyclovir, valacyclovir, or famciclovir is the preferred first-line treatment for HSV-1 gingivostomatitis in immunocompetent patients, and penciclovir cream is not a recommended first-line therapy.