Will antivirals help with oral ulcers (mouth sores)?

From the Guidelines

Antiviral medications can help with mouth sores caused by herpes simplex virus, and the most effective treatment is acyclovir, valacyclovir, or famciclovir, as recommended by the CDC and the National Institutes of Health 1. When it comes to treating mouth sores, it's essential to determine the cause of the sores. For mouth sores caused by herpes simplex virus (cold sores), antiviral medications like acyclovir (400mg three times daily for 5-10 days), valacyclovir (1g twice daily for 7-10 days), or famciclovir (250mg three times daily for 7-10 days) are effective treatments, as stated in the guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents 1. Some key points to consider when treating mouth sores with antiviral medications include:

• Starting treatment at the first sign of symptoms, such as tingling or burning before the sore appears
• Using the medications for the recommended duration, usually 5-10 days
• Considering daily suppressive therapy with lower doses for frequent recurrences
• Being aware that antiviral medications won't help with mouth sores caused by other factors like canker sores, allergic reactions, nutritional deficiencies, or trauma It's also important to note that other treatments, such as topical corticosteroids, analgesics, and oral care protocols, may be recommended for mouth sores caused by other factors, as suggested by the ESMO clinical practice guidelines for diagnosis, treatment, and follow-up of oral and gastrointestinal mucosal injury 1. However, for herpes simplex virus-related mouth sores, antiviral medications are the most effective treatment, and the CDC recommends treating patients with oral valacyclovir, famciclovir, or acyclovir for 5--10 days 1.

From the Research

Antivirals and Mouth Sores

• Antivirals can help with mouth sores caused by herpes simplex virus (HSV) infections, such as herpes labialis (cold sores) and intraoral ulcers 2, 3, 4, 5.
• Topical antiviral agents, such as 5% acyclovir cream/ointment and 1% hydrocortisone cream, can reduce the frequency and severity of recurrent herpes labialis lesions 2.
• Oral antiviral agents, such as acyclovir, valacyclovir, and famciclovir, can shorten the duration of pain and discomfort, hasten healing, and reduce viral shedding in patients with herpes labialis 6, 4, 5.
• Chronic suppressive therapy with oral antiviral agents can be considered for patients with severe or frequent recurrences of herpes labialis 5.
• Antivirals may also be effective in preventing oral ulcers in patients with acute myeloid leukemia receiving remission induction chemotherapy 3.

Types of Antivirals

• Acyclovir is an effective antiviral agent for the treatment of herpes simplex infections, including herpes labialis 2, 6, 3, 4, 5.
• Valacyclovir is a highly bioavailable prodrug of acyclovir and is approved for the treatment of herpes labialis, genital herpes, and herpes zoster 4, 5.
• Famciclovir is another antiviral agent that is effective in the treatment of herpes simplex infections, including herpes labialis 4, 5.

Treatment Considerations

• Episodic treatment with antivirals should be initiated promptly, ideally in the prodromal stage and no later than 48 hours from the onset of lesions to achieve optimal results 5.
• Topical antiviral agents can be used for episodic treatment of herpes labialis, but are not effective in preventing recurrent episodes 5.
• Oral antiviral agents are the treatment of choice for chronic daily suppressive therapy in patients with severe or frequent recurrences of herpes labialis 5.