What is the treatment for severe herpes?

From the Guidelines

Severe herpes infections should be treated with antiviral medications, with acyclovir being the primary treatment option, and for severe cases, intravenous acyclovir or alternative medications like foscarnet for acyclovir-resistant strains should be considered. The treatment approach for severe herpes infections involves the use of antiviral medications to reduce the severity and duration of symptoms. According to the guidelines for treatment of sexually transmitted diseases 1, if lesions persist in a patient receiving acyclovir treatment, resistance of the HSV strain to acyclovir should be suspected, and alternate therapy should be administered.

Some key points to consider in the treatment of severe herpes infections include:

• The use of intravenous acyclovir for severe cases, with dosing recommendations varying based on the severity of the infection and the patient's immune status
• The potential for acyclovir-resistant strains, which may require alternative treatments such as foscarnet, 40 mg/kg body weight IV every 8 hours until clinical resolution is attained 1
• The importance of pain management with medications like acetaminophen or ibuprofen, and the use of topical lidocaine for painful lesions
• The need for patients to keep the affected areas clean and dry to prevent secondary bacterial infections, and to avoid touching lesions and wash hands frequently to prevent spreading the infection

For immunocompromised patients or those with acyclovir-resistant infections, foscarnet (40-60 mg/kg IV every 8 hours) may be necessary, as indicated by the 1999 USPHS/IDSA guidelines for the prevention of opportunistic infections in persons infected with human immunodeficiency virus 1. Additionally, suppressive therapy with daily antivirals may be recommended to reduce frequency and severity of outbreaks in patients with recurrent severe cases.

From the FDA Drug Label

Acyclovir for Injection is indicated for the treatment of severe initial clinical episodes of herpes genitalis in immunocompetent patients. The treatment for severe herpes is acyclovir (IV), as indicated in the drug label 2.

• Key points:
  • Acyclovir is used to treat severe initial clinical episodes of herpes genitalis.
  • It is indicated for use in immunocompetent patients. Note that other treatments may be available, but according to the provided drug label, acyclovir (IV) is a treatment option for severe herpes 2.

From the Research

Treatment Options for Severe Herpes

• The treatment for severe herpes involves the use of antiviral agents, with acyclovir being the standard therapy 3, 4.
• In immunocompetent patients, standard oral acyclovir therapy should be initiated at a dose of 200 mg orally, five times a day for the first 3 to 5 days 3.
• If the response is poor, the dose of oral acyclovir should be increased to 800 mg five times a day 3.
• For immunocompromised patients, treatment options are limited, and the development of resistance to antiviral drugs is a significant concern 3, 4.
• In cases where acyclovir is not effective, alternative regimens such as intravenous foscarnet or cidofovir may be considered 3, 4.

Antiviral Therapy

• Valaciclovir and famciclovir are effective in the treatment of herpes genitalis and acute herpes zoster 4, 5.
• Brivudin and sorivudine have also been successful in the treatment of herpes zoster 4.
• Acyclovir is still the standard therapy for severe herpes simplex virus (HSV) and varicella virus infections 4.

Treatment Protocols

• For patients with severe herpes, a treatment protocol may involve the use of oral acyclovir, followed by intravenous foscarnet or cidofovir if necessary 3.
• The dosage and duration of treatment will depend on the severity of the infection and the patient's response to therapy 3, 6, 7.
• Topical treatment with trifluridine (TFT) may also be effective for accessible mucocutaneous lesions 3.