One-Time Dose of Famciclovir for HSV Type 2
According to the CDC guidelines, a one-time dose regimen of famciclovir is not recommended for HSV type 2 infections in standard clinical practice. Instead, the recommended dosing for famciclovir in treating genital herpes is 250mg orally three times daily for 7-10 days 1.
Recommended Treatment Regimens for HSV-2
For episodic treatment of genital herpes, the CDC recommends:
- Famciclovir 250mg orally three times daily for 7-10 days 1
- Valacyclovir 1g orally twice daily for 7-10 days 1
- Acyclovir 400mg orally three times daily for 7-10 days 1
Important Considerations
- Short-course therapy (1,2, or 3 days) should not be used in patients with HIV infection 2
- For immunocompromised patients, particularly those with HIV, higher doses and longer duration of therapy are recommended 1
Special Populations
HIV-Infected Patients
For HIV-infected individuals with genital HSV:
- Longer treatment courses are necessary 2
- Higher doses may be required 1
- Treatment should be continued until lesions have completely healed 2
Suppressive Therapy Options
For patients with frequent recurrences requiring suppressive therapy:
- Famciclovir 250mg orally twice daily 1
- Valacyclovir 500mg orally twice daily (preferred in HIV-infected persons) 1
- Acyclovir 400mg orally twice daily 1
Dosing Adjustments for Renal Impairment
Famciclovir dosing should be adjusted based on creatinine clearance:
- Normal renal function (≥50 mL/min): No adjustment needed
- Moderate impairment (30-49 mL/min): No adjustment needed
- Severe impairment (10-29 mL/min): Reduced dosing required
- End-stage renal disease (<10 mL/min): Significant dose reduction required
Treatment Failure Considerations
If lesions persist after 7-10 days of therapy:
- Consider acyclovir-resistant HSV 1
- Alternative treatments include IV foscarnet (40mg/kg every 8 hours) or topical cidofovir gel 1% 1
Clinical Evidence
While shorter treatment courses have been studied for recurrent genital herpes (such as the FaST study examining a 2-day famciclovir regimen 3), these abbreviated regimens are not currently recommended in the standard guidelines for initial treatment, particularly for immunocompromised patients.
The evidence consistently supports the use of multi-day regimens rather than single-dose therapy for HSV-2 infections to ensure complete viral suppression and healing of lesions.