Treatment of Herpetic Stomatitis with Vesicular Lesions
For herpetic stomatitis with vesicular lesions, initiate oral acyclovir 15 mg/kg five times daily for 5 days, starting within the first 2-3 days of symptom onset for maximum benefit.
Recommended Treatment Regimen
The CDC recommends oral antiviral therapy as significantly more effective than topical formulations for treating oral herpes infections 1. For herpetic stomatitis specifically:
- Acyclovir 15 mg/kg orally 5 times daily for 5 days is the evidence-based dosing for children with primary herpetic gingivostomatitis 2
- Treatment must be initiated during the prodrome or within 2 days of lesion onset for maximum benefit 1
- Early acyclovir treatment significantly shortens the duration of all clinical manifestations and reduces infectivity compared to placebo 2
Alternative Adult Dosing Options
For adults or when weight-based dosing is impractical, the CDC recommends 1:
- Acyclovir 200 mg orally 5 times daily for 5 days
- Acyclovir 400 mg orally 3 times daily for 5 days
- Acyclovir 800 mg orally 2 times daily for 5 days
Clinical Considerations
Timing is critical: Randomized controlled trials demonstrate that early acyclovir treatment significantly shortens symptom duration and infectivity only when started within the first 3 days of disease onset 2. The typical disease course without treatment lasts approximately 2 weeks 3, 2.
Severe Cases Requiring Hospitalization
- For immunocompromised patients or severe cases with dehydration, consider intravenous acyclovir 5-10 mg/kg IV every 8 hours 4, 5
- Young children may require hospitalization for management of dehydration and pain control 3
- IV therapy is indicated for 7-10 days in severe first-episode and life-threatening infections 5
Important Caveats
- Acyclovir does not eradicate latent virus and will not affect subsequent risk, frequency, or severity of recurrences after discontinuation 1
- Topical acyclovir should be avoided as it is substantially less effective than oral therapy 6
- Patients should abstain from activities that might spread the virus while lesions are present 1
- Suspect acyclovir resistance if lesions do not begin to resolve within 7-10 days of therapy 6, 4
Common Pitfall to Avoid
Do not confuse herpetic stomatitis with aphthous stomatitis (canker sores)—acyclovir is not effective for aphthous stomatitis 7. Herpetic stomatitis presents with clustered vesicles that rupture to form painful ulcers, accompanied by fever and lymphadenopathy 8, 3.