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Herpes simplex - oral - Management
How should topical antiviral preparations be applied?
- Recommended regimen:
- Topical aciclovir 5% cream: apply five times a day at approximately 4-hourly intervals, omitting the night-time application, for 5 days.
- The manufacturer advise that, if healing is not complete then treatment may be continued for up to an additional 5 days [ABPI Medicines Compendium, 2007]. However, CKS could not find any evidence to support this use.
- Topical penciclovir 1% cream: apply to lesions every 2 hours during waking hours, for 4 days.
- Topical antivirals should be used at the first sign of an attack (at erythema or prodromal stage — before vesicles appear).
- Application of topical antiviral preparations:
- Topical antivirals should be dabbed on rather than rubbed in to minimize mechanical trauma to the lesions.
- Hands should be washed after application.
- Topical antiviral preparations should not be shared with other people as this may spread infection.
- Topical antiviral preparations rarely cause adverse effects when used in the short term:
- The most common adverse effects are transient burning or stinging following application and allergic reactions to excipients (e.g. propylene glycol).
[Barbarash, 2001; BNF 54, 2007]
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