From the Guidelines
Acyclovir is the drug of choice for treating herpes labialis in children, regardless of HIV-infection status. When it comes to treating herpes labialis in children, the primary goal is to reduce morbidity, mortality, and improve quality of life. According to the study by 1, acyclovir is the preferred treatment option for herpes simplex virus (HSV) infections, including herpes labialis, in infants and children. The study recommends oral or intravenous preparations of acyclovir, with the dosage and duration of treatment depending on the severity of the infection. Some key points to consider when treating herpes labialis in children include:
- Starting treatment at the first sign of symptoms to reduce the duration and severity of the infection
- Using topical acyclovir 5% cream for children over 2 years, applied 5 times daily for 4-5 days
- Prescribing oral acyclovir at 20 mg/kg (maximum 400 mg) 4-5 times daily for 5-7 days for more severe cases
- Providing supportive care, such as keeping the area clean, applying cold compresses for pain relief, and ensuring adequate hydration
- Using over-the-counter pain relievers like acetaminophen or ibuprofen to manage discomfort
- Identifying and avoiding triggers like sun exposure, stress, or illness to prevent recurrent episodes It's essential to note that treatment with acyclovir has been shown to reduce morbidity and mortality, although infants with neonatal HSV infection remain at risk for neurologic sequelae 1. By following these guidelines and using acyclovir as the primary treatment option, healthcare providers can effectively manage herpes labialis in children and improve their quality of life.
From the FDA Drug Label
1.2 Pediatric Patients
Cold Sores (Herpes Labialis) VALTREX is indicated for the treatment of cold sores (herpes labialis) in pediatric patients aged greater than or equal to 12 years.
The treatment for herpes labialis in children is valacyclovir (PO), but only for pediatric patients aged greater than or equal to 12 years. For children under 12 years, the efficacy and safety of VALTREX have not been established 2.
From the Research
Treatment Options for Herpes Labialis in Children
- Episodic treatment with oral antiviral agents, such as acyclovir, is effective in shortening the duration of pain and discomfort, hastening healing, and reducing viral shedding 3.
- Topical antiviral agents, such as 5% acyclovir cream/ointment, can also be used for episodic treatment of herpes labialis in children 3.
- Chronic suppressive therapy with oral antiviral agents may be considered for patients with severe or frequent recurrences, but this is typically not recommended for children due to the potential for adverse effects and the lack of approval for use in this population 3, 4.
Prevention of Herpes Labialis in Children
- Prompt topical or oral therapy can alleviate symptoms of herpes labialis and contribute to its prevention 5.
- Sunscreens may provide some protection against herpes labialis, but the evidence is mixed and more research is needed to confirm their effectiveness 5.
- Good hygiene practices, such as avoiding sharing utensils or personal items, can help prevent the spread of herpes labialis 6.
Considerations for Treatment in Children
- Valacyclovir and famciclovir are not approved for use in children, so acyclovir is typically the preferred treatment option for herpes labialis in this population 3, 4.
- The treatment of herpes labialis in children should be individualized and based on the severity and frequency of symptoms, as well as the child's overall health status 3, 5.